1
|
Olvera-Barrios A, Mishra AV, Schwartz R, Khatun M, Seltene M, Rutkowska C, Rudnicka AR, Owen CG, Tufail A, A Egan C. Formal registration of visual impairment in people with diabetic retinopathy significantly underestimates the scale of the problem: a retrospective cohort study at a tertiary care eye hospital service in the UK. Br J Ophthalmol 2023; 107:1846-1851. [PMID: 36241373 DOI: 10.1136/bjo-2022-321910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 09/21/2022] [Indexed: 11/03/2022]
Abstract
AIMS To analyse the prevalence of visual impairment (VI), compare it to certification of visual impairment (CVI) and analyse VI associations in patients with diabetic retinopathy (DR). METHODS Retrospective cohort study, which included 8007 patients with DR referred from the English diabetic eye screening programme to a tertiary referral eye hospital. Main outcome measure was VI, defined as vision in the best eye of <6/24. We conducted a multivariable logistic regression for VI as primary outcome of interest, controlling for age, sex, type of diabetes, baseline DR grade, ethnicity and index of multiple deprivation (IMD). RESULTS Mean age was 64.5 (SD 13.6) years; 61% of patients were men; and 31% of South Asian ethnicity. There were 68 patients with CVI during the study period, and 84% (272/325) of patients with VI did not have CVI after a mean follow-up of 1.87 (SD ±0.86) years. Older age showed a positive association with VI (OR per decade rise 1.88, 95% CI 1.70 to 2.08; p=1.8×10-34). Men had a lower risk of VI (OR 0.62, 95% CI 0.50 to 0.79, p=6.0×10-5), and less deprivation had a graded inverse association with VI (OR per IMD category increase 0.83, 95% CI 0.74 to 0.93, p value for linear trend 0.002). CONCLUSION The majority of people with vision impairment are not registered at the point of care, which could translate to underestimation of diabetes-related VI and all-cause VI at a national level if replicated at other centres. Further work is needed to explore rates of VI and uptake of registration.
Collapse
Affiliation(s)
- Abraham Olvera-Barrios
- Medical Retina, Moorfields Eye Hospital NHS Foundation Trust, London, UK
- Institute of Ophthalmology, University College London, London, UK
| | - Amit V Mishra
- Medical Retina, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Roy Schwartz
- Medical Retina, Moorfields Eye Hospital NHS Foundation Trust, London, UK
- Institute of Health Informatics, University College London, London, UK
| | - Mumina Khatun
- Medical Retina, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Michael Seltene
- Medical Retina, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | | | - Alicja R Rudnicka
- Population Health Research Institute, St George's, University of London, London, UK
| | - Christopher G Owen
- Population Health Research Institute, St George's, University of London, London, UK
| | - Adnan Tufail
- Medical Retina, Moorfields Eye Hospital NHS Foundation Trust, London, UK
- Institute of Ophthalmology, University College London, London, UK
| | - Catherine A Egan
- Medical Retina, Moorfields Eye Hospital NHS Foundation Trust, London, UK
- Institute of Ophthalmology, University College London, London, UK
| |
Collapse
|
2
|
Olvera-Barrios A, Rudnicka AR, Anderson J, Bolter L, Chambers R, Warwick AN, Welikala R, Fajtl J, Barman S, Remgnino P, Wu Y, Lee AY, Chew EY, Ferris FL, Hingorani A, Sofat R, A Egan C, Tufail A, Owen CG. Two-year recall for people with no diabetic retinopathy: a multi-ethnic population-based retrospective cohort study using real-world data to quantify the effect. Br J Ophthalmol 2023; 107:1839-1845. [PMID: 37875374 DOI: 10.1136/bjo-2023-324097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 08/19/2023] [Indexed: 10/26/2023]
Abstract
BACKGROUND/AIMS The English Diabetic Eye Screening Programme (DESP) offers people living with diabetes (PLD) annual screening. Less frequent screening has been advocated among PLD without diabetic retinopathy (DR), but evidence for each ethnic group is limited. We examined the potential effect of biennial versus annual screening on the detection of sight-threatening diabetic retinopathy (STDR) and proliferative diabetic retinopathy (PDR) among PLD without DR from a large urban multi-ethnic English DESP. METHODS PLD in North-East London DESP (January 2012 to December 2021) with no DR on two prior consecutive screening visits with up to 8 years of follow-up were examined. Annual STDR and PDR incidence rates, overall and by ethnicity, were quantified. Delays in identification of STDR and PDR events had 2-year screening intervals been used were determined. FINDINGS Among 82 782 PLD (37% white, 36% South Asian, and 16% black people), there were 1788 incident STDR cases over mean (SD) 4.3 (2.4) years (STDR rate 0.51, 95% CI 0.47 to 0.55 per 100-person-years). STDR incidence rates per 100-person-years by ethnicity were 0.55 (95% CI 0.48 to 0.62) for South Asian, 0.34 (95% CI 0.29 to 0.40) for white, and 0.77 (95% CI 0.65 to 0.90) for black people. Biennial screening would have delayed diagnosis by 1 year for 56.3% (1007/1788) with STDR and 43.6% (45/103) with PDR. Standardised cumulative rates of delayed STDR per 100 000 persons for each ethnic group were 1904 (95% CI 1683 to 2154) for black people, 1276 (95% CI 1153 to 1412) for South Asian people, and 844 (95% CI 745 to 955) for white people. INTERPRETATION Biennial screening would have delayed detection of some STDR and PDR by 1 year, especially among those of black ethnic origin, leading to healthcare inequalities.
Collapse
Affiliation(s)
- Abraham Olvera-Barrios
- Institute of Ophthalmology, University College London, London, UK, London, UK
- Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Alicja R Rudnicka
- Population Health Research Institute, St George's, University of London, London, UK
| | - John Anderson
- Homerton Healthcare NHS Foundation Trust, London, UK
| | - Louis Bolter
- Homerton Healthcare NHS Foundation Trust, London, UK
| | - Ryan Chambers
- Homerton Healthcare NHS Foundation Trust, London, UK
| | - Alasdair N Warwick
- Institute of Cardiovascular Science, University College London, London, UK
| | - Roshan Welikala
- Department of Computer Science, Kingston University, Kingston-Upon-Thames, UK
| | - Jiri Fajtl
- Department of Computer Science, Kingston University, Kingston-Upon-Thames, UK
| | - Sarah Barman
- Department of Computer Science, Kingston University, Kingston-Upon-Thames, UK
| | - Paolo Remgnino
- Department of Computer Science, University of Durham, Durham, UK
| | - Yue Wu
- Department of Ophthalmology, University of Washington, Seattle, Washington, USA
| | - Aaron Y Lee
- Department of Ophthalmology, University of Washington, Seattle, Washington, USA
| | - Emily Y Chew
- Division of Epidemiology and Clinical Applications, National Institutes of Health, Bethesda, Maryland, USA
| | | | - Aroon Hingorani
- Institute of Cardiovascular Science, University College London, London, UK
| | - Reecha Sofat
- Department of Pharmacology and Therapeutics, University of Liverpool, Liverpool, UK
| | - Catherine A Egan
- Institute of Ophthalmology, University College London, London, UK, London, UK
- Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Adnan Tufail
- Institute of Ophthalmology, University College London, London, UK, London, UK
- Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Christopher G Owen
- Population Health Research Institute, St George's, University of London, London, UK
| |
Collapse
|
3
|
Yasvoina M, Yang Q, Woods SM, Heeren T, Comer GM, A Egan C, Fruttiger M. Intraretinal pigmented cells in retinal degenerative disease. Br J Ophthalmol 2023; 107:1736-1743. [PMID: 35301216 DOI: 10.1136/bjophthalmol-2021-320392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 02/28/2022] [Indexed: 11/04/2022]
Abstract
PURPOSE Invasion of pigmented cells into the retina occurs in retinal degenerative diseases, such as macular telangiectasia type 2 (MacTel) and retinitis pigmentosa (RP). These intraretinal pigmented cells may be derived from the retinal pigment epithelium (RPE), but differences and similarities between intraretinal pigmented cells and RPE have so far not been well characterised.Clinicopathologic case report. METHOD Here, we compared intraretinal pigment cells with RPE cells by immunohistochemistry. Immunohistological stains for classic RPE markers (RPE65, CRALBP and KRT18) and blood vessel markers (lectin and collagen 4) were done on sections from postmortem eye tissue from two MacTel donors, an RP donor and a control donor. MAIN OUTCOME MEASURES Presence of specific immunohistochemistry markers on intraretinal pigmented and RPE cells. RESULTS We found that intraretinal pigmented cells did not express RPE65 and CRALBP, with a small subset expressing them weakly. However, they all expressed KRT18, which was also present in normal RPE cells. Interestingly, we also found clusters of KRT18-positive cells in the retina that were not pigmented. CONCLUSIONS Our findings suggest that RPE cells invading the retina dedifferentiate (losing classic RPE markers) and can be pigmented or unpigmented. Therefore, the number of RPE cells invading the retina in retinal degenerative disease may be underappreciated by funduscopy.
Collapse
Affiliation(s)
- Marina Yasvoina
- UCL Institute of Ophthalmology, University College London, London, UK
| | - Qian Yang
- UCL Institute of Ophthalmology, University College London, London, UK
| | - Sasha M Woods
- UCL Institute of Ophthalmology, University College London, London, UK
| | - Tjebo Heeren
- Moorfields Eye Hospital, NHS Foundation Trust, London, UK
| | - Grant M Comer
- W.K. Kellogg Eye Center, University of Michigan, Ann Arbor, Michigan, USA
| | | | - Marcus Fruttiger
- UCL Institute of Ophthalmology, University College London, London, UK
| |
Collapse
|
4
|
Okada M, Egan CA, Heeren TFC, Valmaggia P, Tufail A, Maloca PM. State of the art spatial visualization of the response of neovascularisation to anti-vascular endothelial growth factor therapy. Am J Ophthalmol Case Rep 2022; 25:101267. [PMID: 35106403 PMCID: PMC8789520 DOI: 10.1016/j.ajoc.2022.101267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 01/03/2022] [Accepted: 01/10/2022] [Indexed: 11/07/2022] Open
Abstract
PURPOSE To visualize the mode of action of anti-vascular endothelial growth factor (anti-VEGFs) therapy on retinal neovascularization (RNV) in a patient with macular telangiectasia (MacTel) type 2 using a detailed three-dimensional data environment. OBSERVATION A 60-year-old man presented with visual acuity loss and was diagnosed with MacTel type 2. Fluorescein angiography was not possible for safety reasons because of a history of severe reaction to fluorescein dye at his referring hospital. Optical coherence tomography angiography (OCTA) imaging revealed new retinal neovascular membranes (RNV) in the macula of both eyes. A marked reduction in the size of the RNV in both eyes was evident on volume-rendered three-dimensional OCTA retinal imaging after the first anti-VEGF injection. CONCLUSION AND IMPORTANCE The ability to directly observe the effect of anti-VEGF injections on a RNV using three-dimensional OCTA was successfully demonstrated. This can be useful in patients with previous allergic and potentially lethal complications to fluorescein. In addition, enhanced three-dimensional spatial display of RNV leads to a greater understanding of the perfusion profile and the anatomical changes that occur in ocular neovascularization relative to surrounding tissue. This has the potential to provide insight into the pathobiology of angiogenesis.
Collapse
Affiliation(s)
- Mali Okada
- Moorfields Eye Hospital NHS Foundation Trust, London, EC1V 2PD, United Kingdom
- Royal Victorian Eye and Ear Hospital, 32 Gisborne St, East Melbourne, VIC, 3002, Australia
| | - Catherine A. Egan
- Moorfields Eye Hospital NHS Foundation Trust, London, EC1V 2PD, United Kingdom
- Institute of Ophthalmology, University College London, 11-43 Bath St, Greater, London, EC1V 9EL, United Kingdom
| | - Tjebo FC. Heeren
- Moorfields Eye Hospital NHS Foundation Trust, London, EC1V 2PD, United Kingdom
- Institute of Ophthalmology, University College London, 11-43 Bath St, Greater, London, EC1V 9EL, United Kingdom
- Department of Ophthalmology, University of Bonn, 53127, Bonn, Germany
| | - Philippe Valmaggia
- Department of Ophthalmology, University of Basel, Mittlere Str. 91, 4056, Basel, Switzerland
- Institute of Molecular and Clinical Ophthalmology Basel (IOB), Mittlere Strasse 91, Basel, 4056, Switzerland
| | - Adnan Tufail
- Moorfields Eye Hospital NHS Foundation Trust, London, EC1V 2PD, United Kingdom
- Institute of Ophthalmology, University College London, 11-43 Bath St, Greater, London, EC1V 9EL, United Kingdom
| | - Peter M. Maloca
- Moorfields Eye Hospital NHS Foundation Trust, London, EC1V 2PD, United Kingdom
- Department of Ophthalmology, University of Basel, Mittlere Str. 91, 4056, Basel, Switzerland
- Institute of Molecular and Clinical Ophthalmology Basel (IOB), Mittlere Strasse 91, Basel, 4056, Switzerland
| |
Collapse
|
5
|
Xiao B, Mercer GD, Jin L, Lee HL, Chen T, Wang Y, Liu Y, Denniston AK, Egan CA, Li J, Lu Q, Xu P, Congdon N. Outreach screening to address demographic and economic barriers to diabetic retinopathy care in rural China. PLoS One 2022; 17:e0266380. [PMID: 35442967 PMCID: PMC9020743 DOI: 10.1371/journal.pone.0266380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 03/04/2022] [Indexed: 11/25/2022] Open
Abstract
IMPORTANCE Poor access to existing care for diabetic retinopathy (DR) limits effectiveness of proven treatments. OBJECTIVES We examined whether outreach screening in rural China improves equity of access. DESIGN, SETTING AND PARTICIPANTS We compared prevalence of female sex, age > = 65 years, primary education or below, and requiring referral care for DR between three cohorts with diabetes examined for DR in neighboring areas of Guangdong, China: passive case detection at secondary-level hospitals (n = 193); persons screened during primary-level DR outreach (n = 182); and individuals with newly- or previously-diagnosed diabetes in a population survey (n = 579). The latter reflected the "ideal" reach of a screening program. RESULTS Compared to the population cohort, passive case detection reached fewer women (50·8% vs. 62·3%, p = 0·006), older adults (37·8% vs. 51·3%, p < 0·001), and less-educated persons (39·9% vs. 89·6%, p < 0·001). Outreach screening, compared to passive case detection, improved representation of the elderly (49·5% vs. 37·8%, p = 0·03) and less-educated (70·3% vs. 39·9%, p<0·001). The proportion of women (59.8% vs 62.3%, P>0.300) and persons aged > = 65 years (49.5% vs 51.3%, p = 0.723) in the outreach screening and population cohorts did not differ significantly. Prevalence of requiring referral care for DR was significantly higher in the outreach screening cohort (28·0%) than the population (14·0%) and passive case detection cohorts (7·3%, p<0·001 for both). CONCLUSIONS AND RELEVANCE Primary-level outreach screening improves access for the poorly-educated and elderly, and removes gender inequity in access to DR care in this setting, while also identifying more severely-affected patients than case finding in hospital.
Collapse
Affiliation(s)
- Baixiang Xiao
- Affiliated Eye Hospital of Nanchang University, Nanchang City, China
| | - Gareth D. Mercer
- Department of Ophthalmology and Visual Sciences, McGill University, Montréal, Canada
| | - Ling Jin
- The State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou City, China
| | - Han Lin Lee
- Centre for Public Health, Queen’s University Belfast, Belfast, United Kingdom
| | - Tingting Chen
- The Ophthalmology Department of the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Yanfang Wang
- The State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou City, China
| | - Yuanping Liu
- The State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou City, China
| | | | - Catherine A. Egan
- Moorfields Eye Hospital, NHS Foundation Trust, London, United Kingdom
| | - Jia Li
- Orbis International, New York, NY, United States of America
| | - Qing Lu
- Orbis International, New York, NY, United States of America
| | - Ping Xu
- Orbis International, New York, NY, United States of America
| | - Nathan Congdon
- The State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou City, China
- Centre for Public Health, Queen’s University Belfast, Belfast, United Kingdom
- Orbis International, New York, NY, United States of America
- * E-mail:
| |
Collapse
|
6
|
Pauleikhoff L, Heeren TFC, Gliem M, Lim E, Pauleikhoff D, Holz FG, Clemons T, Balaskas K, Egan CA, Charbel Issa P. Fundus Autofluorescence Imaging in Macular Telangiectasia Type 2: MacTel Study Report Number 9. Am J Ophthalmol 2021; 228:27-34. [PMID: 33775659 DOI: 10.1016/j.ajo.2021.03.022] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 03/09/2021] [Accepted: 03/16/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE To investigate the role of fundus autofluorescence (FAF) imaging in the diagnosis of macular telangiectasia type 2 (MacTel) and to describe disease-associated FAF patterns and their origin. DESIGN Cross-sectional multicenter study METHODS: FAF images were collected from the multicenter MacTel Natural History Observation and Registry Study. In a first qualitative approach, common FAF phenotypes were defined and correlated with multimodal imaging. We then evaluated how many eyes showed FAF changes, and temporal vs nasal asymmetry of FAF changes was graded. Finally, 100 eyes of MacTel patients and 100 control eyes (50 normal eyes and 50 eyes with other macular diseases) were combined and 2 masked graders assessed the presence of MacTel based on FAF images alone. RESULTS The study included 807 eyes of 420 patients (33 eyes were excluded owing to poor image quality). Loss of macular pigment, cystoid spaces, pigment plaques, neovascular membranes, and ectatic vascular changes commonly caused characteristic changes on FAF images. All MacTel patients had macular FAF changes in at least 1 eye. In 95% of eyes, these changes were more pronounced temporally than nasally. Common FAF patterns were increased (60%) and mixed/decreased FAF (38%) and/or visibility of vascular changes such as blunted vessels or ectatic capillaries (79%). Based on those features, high diagnostic performance was achieved for detection of the disease based on FAF alone (Youden index up to 0.91). CONCLUSIONS The study demonstrates that MacTel is consistently associated with disease-specific changes on FAF imaging. Those changes are typically more pronounced in the temporal parafovea.
Collapse
Affiliation(s)
- Laurenz Pauleikhoff
- From the Oxford Eye Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom; Nuffield Laboratory of Ophthalmology, Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom; Eye Center, Medical Center, University of Freiburg, Freiburg im Breisgau, Germany
| | - Tjebo F C Heeren
- Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom
| | - Martin Gliem
- From the Oxford Eye Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom; Nuffield Laboratory of Ophthalmology, Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
| | - Ernest Lim
- From the Oxford Eye Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | | | - Frank G Holz
- Department of Ophthalmology, University of Bonn, Bonn, Germany
| | | | | | - Catherine A Egan
- Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom
| | - Peter Charbel Issa
- From the Oxford Eye Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom; Nuffield Laboratory of Ophthalmology, Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom.
| |
Collapse
|
7
|
Liefers B, Taylor P, Alsaedi A, Bailey C, Balaskas K, Dhingra N, Egan CA, Rodrigues FG, Gonzalo CG, Heeren TF, Lotery A, Müller PL, Olvera-Barrios A, Paul B, Schwartz R, Thomas DS, Warwick AN, Tufail A, Sánchez CI. Quantification of Key Retinal Features in Early and Late Age-Related Macular Degeneration Using Deep Learning. Am J Ophthalmol 2021; 226:1-12. [PMID: 33422464 DOI: 10.1016/j.ajo.2020.12.034] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 12/28/2020] [Accepted: 12/28/2020] [Indexed: 02/01/2023]
Abstract
PURPOSE We sought to develop and validate a deep learning model for segmentation of 13 features associated with neovascular and atrophic age-related macular degeneration (AMD). DESIGN Development and validation of a deep-learning model for feature segmentation. METHODS Data for model development were obtained from 307 optical coherence tomography volumes. Eight experienced graders manually delineated all abnormalities in 2712 B-scans. A deep neural network was trained with these data to perform voxel-level segmentation of the 13 most common abnormalities (features). For evaluation, 112 B-scans from 112 patients with a diagnosis of neovascular AMD were annotated by 4 independent observers. The main outcome measures were Dice score, intraclass correlation coefficient, and free-response receiver operating characteristic curve. RESULTS On 11 of 13 features, the model obtained a mean Dice score of 0.63 ± 0.15, compared with 0.61 ± 0.17 for the observers. The mean intraclass correlation coefficient for the model was 0.66 ± 0.22, compared with 0.62 ± 0.21 for the observers. Two features were not evaluated quantitatively because of a lack of data. Free-response receiver operating characteristic analysis demonstrated that the model scored similar or higher sensitivity per false positives compared with the observers. CONCLUSIONS The quality of the automatic segmentation matches that of experienced graders for most features, exceeding human performance for some features. The quantified parameters provided by the model can be used in the current clinical routine and open possibilities for further research into treatment response outside clinical trials.
Collapse
|
8
|
Bonelli R, Jackson VE, Prasad A, Munro JE, Farashi S, Heeren TFC, Pontikos N, Scheppke L, Friedlander M, Egan CA, Allikmets R, Ansell BRE, Bahlo M. Author Correction: Identification of genetic factors influencing metabolic dysregulation and retinal support for MacTel, a retinal disorder. Commun Biol 2021; 4:473. [PMID: 33837246 PMCID: PMC8035146 DOI: 10.1038/s42003-021-01972-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
A Correction to this paper has been published: https://doi.org/10.1038/s42003-021-01972-y
Collapse
Affiliation(s)
- Roberto Bonelli
- Population Health and Immunity Division, Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, Australia.,Department of Medical Biology, University of Melbourne, Parkville, VIC, Australia
| | - Victoria E Jackson
- Population Health and Immunity Division, Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, Australia.,Department of Medical Biology, University of Melbourne, Parkville, VIC, Australia
| | - Aravind Prasad
- Population Health and Immunity Division, Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, Australia.,Department of Medical Biology, University of Melbourne, Parkville, VIC, Australia
| | - Jacob E Munro
- Population Health and Immunity Division, Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, Australia.,Department of Medical Biology, University of Melbourne, Parkville, VIC, Australia
| | - Samaneh Farashi
- Population Health and Immunity Division, Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, Australia.,Department of Medical Biology, University of Melbourne, Parkville, VIC, Australia
| | - Tjebo F C Heeren
- Moorfields Eye Hospital NHS Foundation Trust, London, UK.,University College London Institute of Ophthalmology, London, UK
| | - Nikolas Pontikos
- Moorfields Eye Hospital NHS Foundation Trust, London, UK.,University College London Institute of Ophthalmology, London, UK
| | - Lea Scheppke
- The Lowy Medical Research Institute, La Jolla, CA, USA
| | - Martin Friedlander
- The Lowy Medical Research Institute, La Jolla, CA, USA.,Department of Molecular Medicine, The Scripps Research Institute, La Jolla, CA, USA
| | | | | | - Rando Allikmets
- Department of Ophthalmology, Columbia University, New York, NY, USA.,Department of Pathology and Cell Biology, Columbia University, New York, NY, USA
| | - Brendan R E Ansell
- Population Health and Immunity Division, Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, Australia.,Department of Medical Biology, University of Melbourne, Parkville, VIC, Australia
| | - Melanie Bahlo
- Population Health and Immunity Division, Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, Australia. .,Department of Medical Biology, University of Melbourne, Parkville, VIC, Australia.
| |
Collapse
|
9
|
Bonelli R, Jackson VE, Prasad A, Munro JE, Farashi S, Heeren TFC, Pontikos N, Scheppke L, Friedlander M, Egan CA, Allikmets R, Ansell BRE, Bahlo M. Identification of genetic factors influencing metabolic dysregulation and retinal support for MacTel, a retinal disorder. Commun Biol 2021; 4:274. [PMID: 33654266 PMCID: PMC7925591 DOI: 10.1038/s42003-021-01788-w] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 01/27/2021] [Indexed: 01/31/2023] Open
Abstract
Macular Telangiectasia Type 2 (MacTel) is a rare degenerative retinal disease with complex genetic architecture. We performed a genome-wide association study on 1,067 MacTel patients and 3,799 controls, which identified eight novel genome-wide significant loci (p < 5 × 10-8), and confirmed all three previously reported loci. Using MAGMA, eQTL and transcriptome-wide association analysis, we prioritised 48 genes implicated in serine-glycine biosynthesis, metabolite transport, and retinal vasculature and thickness. Mendelian randomization indicated a likely causative role of serine (FDR = 3.9 × 10-47) and glycine depletion (FDR = 0.006) as well as alanine abundance (FDR = 0.009). Polygenic risk scoring achieved an accuracy of 0.74 and was associated in UKBiobank with retinal damage (p = 0.009). This represents the largest genetic study on MacTel to date and further highlights genetically-induced systemic and tissue-specific metabolic dysregulation in MacTel patients, which impinges on retinal health.
Collapse
Affiliation(s)
- Roberto Bonelli
- grid.1042.7Population Health and Immunity Division, Walter and Eliza Hall Institute of Medical Research, Parkville, VIC Australia ,grid.1008.90000 0001 2179 088XDepartment of Medical Biology, University of Melbourne, Parkville, VIC Australia
| | - Victoria E. Jackson
- grid.1042.7Population Health and Immunity Division, Walter and Eliza Hall Institute of Medical Research, Parkville, VIC Australia ,grid.1008.90000 0001 2179 088XDepartment of Medical Biology, University of Melbourne, Parkville, VIC Australia
| | - Aravind Prasad
- grid.1042.7Population Health and Immunity Division, Walter and Eliza Hall Institute of Medical Research, Parkville, VIC Australia ,grid.1008.90000 0001 2179 088XDepartment of Medical Biology, University of Melbourne, Parkville, VIC Australia
| | - Jacob E. Munro
- grid.1042.7Population Health and Immunity Division, Walter and Eliza Hall Institute of Medical Research, Parkville, VIC Australia ,grid.1008.90000 0001 2179 088XDepartment of Medical Biology, University of Melbourne, Parkville, VIC Australia
| | - Samaneh Farashi
- grid.1042.7Population Health and Immunity Division, Walter and Eliza Hall Institute of Medical Research, Parkville, VIC Australia ,grid.1008.90000 0001 2179 088XDepartment of Medical Biology, University of Melbourne, Parkville, VIC Australia
| | - Tjebo F. C. Heeren
- grid.436474.60000 0000 9168 0080Moorfields Eye Hospital NHS Foundation Trust, London, UK ,grid.83440.3b0000000121901201University College London Institute of Ophthalmology, London, UK
| | - Nikolas Pontikos
- grid.436474.60000 0000 9168 0080Moorfields Eye Hospital NHS Foundation Trust, London, UK ,grid.83440.3b0000000121901201University College London Institute of Ophthalmology, London, UK
| | - Lea Scheppke
- grid.489357.4The Lowy Medical Research Institute, La Jolla, CA USA
| | - Martin Friedlander
- grid.489357.4The Lowy Medical Research Institute, La Jolla, CA USA ,grid.214007.00000000122199231Department of Molecular Medicine, The Scripps Research Institute, La Jolla, CA USA
| | | | - Catherine A. Egan
- grid.436474.60000 0000 9168 0080Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Rando Allikmets
- grid.21729.3f0000000419368729Department of Ophthalmology, Columbia University, New York, NY USA ,grid.21729.3f0000000419368729Department of Pathology and Cell Biology, Columbia University, New York, NY USA
| | - Brendan R. E. Ansell
- grid.1042.7Population Health and Immunity Division, Walter and Eliza Hall Institute of Medical Research, Parkville, VIC Australia ,grid.1008.90000 0001 2179 088XDepartment of Medical Biology, University of Melbourne, Parkville, VIC Australia
| | - Melanie Bahlo
- grid.1042.7Population Health and Immunity Division, Walter and Eliza Hall Institute of Medical Research, Parkville, VIC Australia ,grid.1008.90000 0001 2179 088XDepartment of Medical Biology, University of Melbourne, Parkville, VIC Australia
| |
Collapse
|
10
|
Bonelli R, Woods SM, Ansell BRE, Heeren TFC, Egan CA, Khan KN, Guymer R, Trombley J, Friedlander M, Bahlo M, Fruttiger M. Systemic lipid dysregulation is a risk factor for macular neurodegenerative disease. Sci Rep 2020; 10:12165. [PMID: 32699277 PMCID: PMC7376024 DOI: 10.1038/s41598-020-69164-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 07/07/2020] [Indexed: 01/01/2023] Open
Abstract
Macular Telangiectasia type 2 (MacTel) is an uncommon bilateral retinal disease, in which glial cell and photoreceptor degeneration leads to central vision loss. The causative disease mechanism is largely unknown, and no treatment is currently available. A previous study found variants in genes associated with glycine-serine metabolism (PSPH, PHGDH and CPS1) to be associated with MacTel, and showed low levels of glycine and serine in the serum of MacTel patients. Recently, a causative role of deoxysphingolipids in MacTel disease has been established. However, little is known about possible other metabolic dysregulation. Here we used a global metabolomics platform in a case-control study to comprehensively profile serum from 60 MacTel patients and 58 controls. Analysis of the data, using innovative computational approaches, revealed a detailed, disease-associated metabolic profile with broad changes in multiple metabolic pathways. This included alterations in the levels of several metabolites that are directly or indirectly linked to glycine-serine metabolism, further validating our previous genetic findings. We also found changes unrelated to PSPH, PHGDH and CPS1 activity. Most pronounced, levels of several lipid groups were altered, with increased phosphatidylethanolamines being the most affected lipid group. Assessing correlations between different metabolites across our samples revealed putative functional connections. Correlations between phosphatidylethanolamines and sphingomyelin, and glycine-serine and sphingomyelin, observed in controls, were reduced in MacTel patients, suggesting metabolic re-wiring of sphingomyelin metabolism in MacTel patients. Our findings provide novel insights into metabolic changes associated with MacTel and implicate altered lipid metabolism as a contributor to this retinal neurodegenerative disease.
Collapse
Affiliation(s)
- Roberto Bonelli
- The Walter and Eliza Hall Institute of Medical Research, 1G Royal Parade, Parkville, VIC, 3052, Australia
- Department of Medical Biology, The University of Melbourne, Melbourne, VIC, 3010, Australia
| | - Sasha M Woods
- UCL Institute of Ophthalmology, University College London, 11-43 Bath St, London, EC1V 9EL, UK
| | - Brendan R E Ansell
- The Walter and Eliza Hall Institute of Medical Research, 1G Royal Parade, Parkville, VIC, 3052, Australia
- Department of Medical Biology, The University of Melbourne, Melbourne, VIC, 3010, Australia
| | - Tjebo F C Heeren
- UCL Institute of Ophthalmology, University College London, 11-43 Bath St, London, EC1V 9EL, UK
- Moorfields Eye Hospital NHS Foundation Trust, City Road, London, EC1, UK
| | - Catherine A Egan
- Moorfields Eye Hospital NHS Foundation Trust, City Road, London, EC1, UK
| | - Kamron N Khan
- The Leeds Teaching Hospitals NHS Trust, St. James's Hospital, Leeds, LS9 7TF, UK
| | - Robyn Guymer
- Department of Surgery, Center for Eye Research Australia, Royal Victorian Eye and Ear Hospital, and Ophthalmology, 32 Gisborne St, East Melbourne, VIC, 3002, Australia
| | | | - Martin Friedlander
- Lowy Medical Research Institute, La Jolla, CA, USA
- The Scripps Research Institute, La Jolla, CA, USA
| | - Melanie Bahlo
- The Walter and Eliza Hall Institute of Medical Research, 1G Royal Parade, Parkville, VIC, 3052, Australia
- Department of Medical Biology, The University of Melbourne, Melbourne, VIC, 3010, Australia
| | - Marcus Fruttiger
- UCL Institute of Ophthalmology, University College London, 11-43 Bath St, London, EC1V 9EL, UK.
| |
Collapse
|
11
|
Heeren TFC, Chew EY, Clemons T, Fruttiger M, Balaskas K, Schwartz R, Egan CA, Charbel Issa P. Macular Telangiectasia Type 2: Visual Acuity, Disease End Stage, and the MacTel Area: MacTel Project Report Number 8. Ophthalmology 2020; 127:1539-1548. [PMID: 32586743 DOI: 10.1016/j.ophtha.2020.03.040] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 03/21/2020] [Accepted: 03/31/2020] [Indexed: 11/28/2022] Open
Abstract
PURPOSE To report the visual acuity measures from the macular telangiectasia type 2 (MacTel) registry and to investigate and describe phenotypic findings in eyes with substantial vision loss resulting from MacTel. DESIGN Cross-sectional multicenter study. PARTICIPANTS Participants in the MacTel Natural History Observation Registration Study. METHODS Best-corrected visual acuity (BCVA) data, retinal imaging data, and clinical data were accessed from the MacTel Study databases in May 2019. MAIN OUTCOME MEASURES Frequency distribution of BCVA and its relationship to age; morphologic changes in eyes with very late disease stages, defined by a BCVA of 20/200 or worse; average retinal thickness of macular subfields on OCT; and dimensions of the area affected by MacTel (i.e., the MacTel area). RESULTS Best-corrected visual acuity was 20/50 or worse in 37.3% and 20/200 or worse in 3.8% of 4449 eyes of 2248 patients; 18.4% and 0.7% of all patients showed bilateral BCVA of 20/50 or worse and 20/200 or worse, respectively. Asymmetry between right and left eyes was present (median BCVA, 71 letters vs. 74 letters), a finding supported by more advanced morphologic changes in right eyes. Participant age correlated with BCVA, but the effect size was small. If a neovascularization or macular hole were present, bilateral occurrence was frequent (33% or 17%, respectively), and BCVA was better than 20/200 (79% or 78%, respectively) or 20/50 or better (26% or 13%, respectively). Eyes with advanced disease (BCVA, ≤20/200) showed the following characteristics: (1) atrophy of the foveal photoreceptor layer with or without associated subretinal fibrosis; (2) an affected area, termed MacTel area, limited to a horizontal diameter not exceeding the distance between the temporal optic disc margin and foveal center, and the vertical diameter not exceeding approximately 0.8 times this distance (exceptions were eyes with large active or inactive neovascular membranes); (3) reduced retinal thickness measures within the MacTel area; and (4) less frequent retinal greying and more frequent hyperpigmentations compared with eyes that have better BCVA. CONCLUSIONS Severe vision loss is rare in MacTel and is related to photoreceptor atrophy in most people. Results indicate disease asymmetry with slightly worse vision and more advanced disease manifestation in right eyes. MacTel-related neurodegeneration does not spread beyond the limits of the MacTel area.
Collapse
Affiliation(s)
- Tjebo F C Heeren
- Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom; UCL Institute of Ophthalmology, University College London, London, United Kingdom
| | - Emily Y Chew
- Division of Epidemiology and Clinical Applications, National Eye Institute, National Institutes of Health, Bethesda, Maryland
| | | | - Marcus Fruttiger
- UCL Institute of Ophthalmology, University College London, London, United Kingdom
| | | | - Roy Schwartz
- Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom
| | - Catherine A Egan
- Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom
| | - Peter Charbel Issa
- Oxford Eye Hospital, Oxford University Hospitals NHS Foundation Trust, and Nuffield Laboratory of Ophthalmology, Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom.
| | | |
Collapse
|
12
|
Egan CA, Webster CA, Beets MW, Weaver RG, Russ L, Michael D, Nesbitt D, Orendorff KL. Sedentary Time and Behavior during School: A Systematic Review and Meta-Analysis. American Journal of Health Education 2019. [DOI: 10.1080/19325037.2019.1642814] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
|
13
|
Okada M, Heeren TFC, Mulholland PJ, Maloca PM, Cilkova M, Rocco V, Fruttiger M, Egan CA, Anderson RS, Tufail A. High-Resolution In Vivo Fundus Angiography using a Nonadaptive Optics Imaging System. Transl Vis Sci Technol 2019; 8:54. [PMID: 31293809 PMCID: PMC6602143 DOI: 10.1167/tvst.8.3.54] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Accepted: 03/01/2019] [Indexed: 01/05/2023] Open
Abstract
Purpose We provide a proof of concept for the detailed characterization of retinal capillary features and surrounding photoreceptor mosaic using a customized nonadaptive optics angiography imaging system. Methods High-resolution fluorescein angiography (FFA) and/or indocyanine green angiography (ICGA) images were obtained using a modified Heidelberg retina angiograph (HRA2) device with a reduced scan angle enabling 3° field of view. Colocalized images of the photoreceptor mosaic also were captured in vivo using the same instrument. Visibility of vascular subbranches were compared between high-resolution images and conventional fundus angiography (FA) with a 30° field of view. Results High-resolution angiographic and infrared images (3° × 3° field of view, a 10-fold magnification) were obtained in 10 participants. These included seven patients with various retinal diseases, including myopic degeneration, diabetic retinopathy, macular telangiectasia, and central serous chorioretinopathy, as well as three healthy controls. Images of the retinal vasculature down to the capillary level were obtained on angiography with the ability to visualize a mean 1.2 levels more subbranches compared to conventional FA. In addition, imaging of the photoreceptor cone mosaic, to a sufficient resolution to calculate cone density, was possible. Movement of blood cells within the vasculature also was discernible on infrared videography. Conclusions This exploratory study demonstrates that fast high-resolution angiography and cone visualization is feasible using a commercially available imaging system. Translational Relevance This offers potential to better understand the relationship between the retinal neurovascular system in health and disease and the timing of therapeutic interventions in disease states.
Collapse
Affiliation(s)
- Mali Okada
- Royal Victorian Eye and Ear Hospital, Melbourne, Australia.,Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Tjebo F C Heeren
- Moorfields Eye Hospital NHS Foundation Trust, London, UK.,Institute of Ophthalmology, University College London, London, UK
| | - Pádraig J Mulholland
- Moorfields Eye Hospital NHS Foundation Trust, London, UK.,Institute of Ophthalmology, University College London, London, UK.,Optometry and Vision Sciences Research Group, School of Biomedical Science, Ulster University, Coleraine, Northern Ireland
| | - Peter M Maloca
- Moorfields Eye Hospital NHS Foundation Trust, London, UK.,OCTlab, Department of Ophthalmology, University Hospital Basel, Basel, Switzerland.,Institute of Molecular and Clinical Ophthalmology Basel (IOB), Basel, Switzerland.,Department of Ophthalmology, University of Basel, Basel, Switzerland
| | - Marketa Cilkova
- Institute of Ophthalmology, University College London, London, UK
| | - Vincent Rocco
- Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Marcus Fruttiger
- Institute of Ophthalmology, University College London, London, UK
| | - Catherine A Egan
- Moorfields Eye Hospital NHS Foundation Trust, London, UK.,Institute of Ophthalmology, University College London, London, UK
| | - Roger S Anderson
- Moorfields Eye Hospital NHS Foundation Trust, London, UK.,Institute of Ophthalmology, University College London, London, UK.,Optometry and Vision Sciences Research Group, School of Biomedical Science, Ulster University, Coleraine, Northern Ireland
| | - Adnan Tufail
- Moorfields Eye Hospital NHS Foundation Trust, London, UK.,Institute of Ophthalmology, University College London, London, UK
| |
Collapse
|
14
|
Denniston AK, Lee AY, Lee CS, Crabb DP, Bailey C, Lip PL, Taylor P, Pikoula M, Cook E, Akerele T, Antcliff R, Brand C, Chakravarthy U, Chavan R, Dhingra N, Downey L, Eleftheriadis H, Ghanchi F, Khan R, Kumar V, Lobo A, Lotery A, Menon G, Mukherjee R, Palmer H, Patra S, Paul B, Sim DA, Talks JS, Wilkinson E, Tufail A, Egan CA. United Kingdom Diabetic Retinopathy Electronic Medical Record (UK DR EMR) Users Group: report 4, real-world data on the impact of deprivation on the presentation of diabetic eye disease at hospital services. Br J Ophthalmol 2019; 103:837-843. [PMID: 30269098 PMCID: PMC6582816 DOI: 10.1136/bjophthalmol-2018-312568] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 06/20/2018] [Accepted: 07/07/2018] [Indexed: 12/21/2022]
Abstract
AIM To assess the impact of deprivation on diabetic retinopathy presentation and related treatment interventions, as observed within the UK hospital eye service. METHODS This is a multicentre, national diabetic retinopathy database study with anonymised data extraction across 22 centres from an electronic medical record system. The following were the inclusion criteria: all patients with diabetes and a recorded, structured diabetic retinopathy grade. The minimum data set included, for baseline, age and Index of Multiple Deprivation, based on residential postcode; and for all time points, visual acuity, ETDRS grading of retinopathy and maculopathy, and interventions (laser, intravitreal therapies and surgery). The main outcome measures were (1) visual acuity and binocular visual state, and (2) presence of sight-threatening complications and need for early treatment. RESULTS 79 775 patients met the inclusion criteria. Deprivation was associated with later presentation in patients with diabetic eye disease: the OR of being sight-impaired at entry into the hospital eye service (defined as 6/18 to better than 3/60 in the better seeing eye) was 1.29 (95% CI 1.20 to 1.39) for the most deprived decile vs 0.77 (95% CI 0.70 to 0.86) for the least deprived decile; the OR for being severely sight-impaired (3/60 or worse in the better seeing eye) was 1.17 (95% CI 0.90 to 1.55) for the most deprived decile vs 0.88 (95% CI 0.61 to 1.27) for the least deprived decile (reference=fifth decile in all cases). There is also variation in sight-threatening complications at presentation and treatment undertaken: the least deprived deciles had lower chance of having a tractional retinal detachment (OR=0.48 and 0.58 for deciles 9 and 10, 95% CI 0.24 to 0.90 and 0.29 to 1.09, respectively); in terms of accessing treatment, the rate of having a vitrectomy was lowest in the most deprived cohort (OR=0.34, 95% CI 0.19 to 0.58). CONCLUSIONS This large real-world study suggests that first presentation at a hospital eye clinic with visual loss or sight-threatening diabetic eye disease is associated with deprivation. These initial hospital visits represent the first opportunities to receive treatment and to formally engage with support services. Such patients are more likely to be sight-impaired or severely sight-impaired at presentation, and may need additional resources to engage with the hospital eye services over complex treatment schedules.
Collapse
Affiliation(s)
- Alastair K Denniston
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- University of Birmingham, Birmingham, UK
- NIHR Biomedical Research Centre at Moorfields Eye Hospitals NHS Foundation Trust, University College London Institute of Ophthalmology, London, UK
| | - Aaron Y Lee
- University of Washington, Seattle, Washington, USA
| | | | | | - Clare Bailey
- University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Peck-Lin Lip
- Birmingham and Midland Eye Centre, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK
| | - Paul Taylor
- Institute of Health Informatics, University College London, London, UK
| | - Maria Pikoula
- Institute of Health Informatics, University College London, London, UK
| | - Esther Cook
- East Kent Hospitals University NHS Foundation Trust, Kent, UK
| | - Toks Akerele
- Hinchingbrooke Health Care NHS Trust, Hinchingbrooke, UK
| | | | | | | | - Randhir Chavan
- Birmingham and Midland Eye Centre, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK
| | | | - Louise Downey
- Hull and East Yorkshire Hospitals NHS Foundation Trust, Hull, UK
| | | | - Faruque Ghanchi
- Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Rehna Khan
- Calderdale and Huddersfield NHS Foundation Trust, Calderdale, UK
| | - Vineeth Kumar
- Wirral University Teaching Hospital NHS Foundation Trust, Wirral, UK
| | - Aires Lobo
- Moorfields Eye Centre at Bedford Hospital, Bedford, UK
| | - Andrew Lotery
- Faculty of Medicine, University of Southampton, Southampton, UK
| | - Geeta Menon
- Frimley Park Hospital NHS Foundation Trust, Frimley, UK
| | | | - Helen Palmer
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | | | - Bobby Paul
- Barking, Havering and Redbridge University Hospitals NHS Trust, Romford, UK
| | - Dawn A Sim
- Moorfields Eye Centre at Croydon University Hospital, London, UK
| | | | | | - Adnan Tufail
- NIHR Biomedical Research Centre at Moorfields Eye Hospitals NHS Foundation Trust, University College London Institute of Ophthalmology, London, UK
| | - Catherine A Egan
- NIHR Biomedical Research Centre at Moorfields Eye Hospitals NHS Foundation Trust, University College London Institute of Ophthalmology, London, UK
| |
Collapse
|
15
|
Kihara Y, Heeren TFC, Lee CS, Wu Y, Xiao S, Tzaridis S, Holz FG, Charbel Issa P, Egan CA, Lee AY. Estimating Retinal Sensitivity Using Optical Coherence Tomography With Deep-Learning Algorithms in Macular Telangiectasia Type 2. JAMA Netw Open 2019; 2:e188029. [PMID: 30735236 PMCID: PMC6484597 DOI: 10.1001/jamanetworkopen.2018.8029] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
IMPORTANCE As currently used, microperimetry is a burdensome clinical testing modality for testing retinal sensitivity requiring long testing times and trained technicians. OBJECTIVE To create a deep-learning network that could directly estimate function from structure de novo to provide an en face high-resolution map of estimated retinal sensitivity. DESIGN, SETTING, AND PARTICIPANTS A cross-sectional imaging study using data collected between January 1, 2016, and November 30, 2017, from the Natural History Observation and Registry of macular telangiectasia type 2 (MacTel) evaluated 38 participants with confirmed MacTel from 2 centers. MAIN OUTCOMES AND MEASURES Mean absolute error of estimated compared with observed retinal sensitivity. Observed retinal sensitivity was obtained with fundus-controlled perimetry (microperimetry). Estimates of retinal sensitivity were made with deep-learning models that learned on superpositions of high-resolution optical coherence tomography (OCT) scans and microperimetry results. Those predictions were used to create high-density en face sensitivity maps of the macula. Training, validation, and test sets were segregated at the patient level. RESULTS A total of 2499 microperimetry sensitivities were mapped onto 1708 OCT B-scans from 63 eyes of 38 patients (mean [SD] age, 74.3 [9.7] years; 15 men [39.5%]). The numbers of examples for our algorithm were 67 899 (103 053 after data augmentation) for training, 1695 for validation, and 1212 for testing. Mean absolute error results were 4.51 dB (95% CI, 4.36-4.65 dB) when using linear regression and 3.66 dB (95% CI, 3.53-3.78 dB) when using the LeNet model. Using a 49.9 million-variable deep-learning model, a mean absolute error of 3.36 dB (95% CI, 3.25-3.48 dB) of retinal sensitivity for validation and test was achieved. Correlation showed a high degree of agreement (Pearson correlation r = 0.78). By paired Wilcoxon rank sum test, our model significantly outperformed these 2 baseline models (P < .001). CONCLUSIONS AND RELEVANCE High-resolution en face maps of estimated retinal sensitivities were created in eyes with MacTel. The maps were of unequalled resolution compared with microperimetry and were able to correctly delineate functionally healthy and impaired retina. This model may be useful to monitor structural and functional disease progression and has potential as an objective surrogate outcome measure in investigational trials.
Collapse
Affiliation(s)
- Yuka Kihara
- Department of Ophthalmology, University of Washington, Seattle
| | - Tjebo F. C. Heeren
- Moorfields Eye Hospital National Health Service Foundation Trust, London, United Kingdom
- UCL Institute of Ophthalmology, University College London, London, United Kingdom
| | - Cecilia S. Lee
- Department of Ophthalmology, University of Washington, Seattle
| | - Yue Wu
- Department of Ophthalmology, University of Washington, Seattle
| | - Sa Xiao
- Department of Ophthalmology, University of Washington, Seattle
| | - Simone Tzaridis
- Department of Ophthalmology, University of Bonn, Bonn, Germany
| | - Frank G. Holz
- Department of Ophthalmology, University of Bonn, Bonn, Germany
| | - Peter Charbel Issa
- Oxford Eye Hospital, Oxford University Hospitals National Health Service Foundation Trust, Oxford, United Kingdom
- Nuffield Laboratory of Ophthalmology, Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
| | - Catherine A. Egan
- Moorfields Eye Hospital National Health Service Foundation Trust, London, United Kingdom
- UCL Institute of Ophthalmology, University College London, London, United Kingdom
| | - Aaron Y. Lee
- Department of Ophthalmology, University of Washington, Seattle
- eScience Institute, University of Washington, Seattle, Washington
| |
Collapse
|
16
|
Müller S, Heeren TFC, Bonelli R, Fruttiger M, Charbel Issa P, Egan CA, Holz FG. Contrast sensitivity and visual acuity under low light conditions in macular telangiectasia type 2. Br J Ophthalmol 2018; 103:398-403. [DOI: 10.1136/bjophthalmol-2017-311785] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Accepted: 04/22/2018] [Indexed: 11/04/2022]
Abstract
Background/AimMacular pigment optical density (MPOD) is centrally depleted early on in macular telangiectasia type 2 (MacTel). Contrast sensitivity (CS) might be related to MPOD, and thus impaired in early MacTel. The effect of low luminance was assessed on both CS and best corrected visual acuity (BCVA).MethodsThis is a cross-sectional study. Pelli-Robson charts were used for CS testing at 1 m in photopic (110 lux) and mesopic (1 lux) conditions. BCVA was tested with ETDRS charts and low luminance visual acuity (LLVA) with a 2.0 log unit neutral density filter. MPOD was obtained with dual-wavelength autofluorescence.ResultsOne hundred and three eyes of 52 patients with MacTel (mean±SD age 62.9±10.2, range 35–77) were compared with 34 healthy eyes of 17 controls (mean±SD age 65.2±7.4, range 53–78). CS was significantly lower in the eyes with MacTel. This impairment was higher in low light conditions (low light contrast sensitivity (LL-CS)). Eyes at the early stages of MacTel had significantly lower LL-CS than controls, but normal (photopic) CS. The results were similar but less pronounced for BCVA/LLVA. Decrease in CS was correlated with loss of MPOD.ConclusionsLow light conditions have a detrimental effect on visual performance in MacTel. Impaired CS might correlate with MPOD depletion as a pathognomonic finding in MacTel. Functional impairment might precede structural disintegration, indicating dysfunction at the cellular level. The applied tests might be useful as additional functional assessments in clinical routine and as outcome measures in future interventional clinical trials.
Collapse
|
17
|
Lee AY, Butt T, Chew E, Agron E, Clemons TE, Egan CA, Lee CS, Tufail A. Cost-effectiveness of age-related macular degeneration study supplements in the UK: combined trial and real-world outcomes data. Br J Ophthalmol 2017; 102:465-472. [PMID: 28835423 DOI: 10.1136/bjophthalmol-2017-310939] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Revised: 07/22/2017] [Accepted: 07/24/2017] [Indexed: 11/03/2022]
Abstract
AIMS To evaluate the cost-effectiveness of Age-Related Eye Disease Study (AREDS) 1 & 2 supplements in patients with either bilateral intermediate age-related macular degeneration, AREDS category 3, or unilateral neovascular age-related macular degeneration AMD (nAMD), AREDS category 4. METHODS A patient-level health state transition model based on levels of visual acuity in the better-seeing eye was constructed to simulate the costs and consequences of patients taking AREDS vitamin supplements. SETTING UK National Health Service (NHS). The model was populated with data from AREDS and real-world outcomes and resource use from a prospective multicentre national nAMD database study containing 92 976 ranibizumab treatment episodes. INTERVENTIONS Two treatment approaches were compared: immediate intervention with AREDS supplements or no supplements. MAIN OUTCOME MEASURES quality-adjusted life years (QALYs) and healthcare costs were accrued for each strategy, and incremental costs and QALYs were calculated for the lifetime of the patient. One-way and probabilistic sensitivity analyses were employed to test the uncertainty of the model. RESULTS For AREDS category 3, the incremental cost-effectiveness ratio was £30 197. For AREDS category 4 compared with no intervention, AREDS supplements are more effective (10.59 vs 10.43 QALYs) and less costly (£52 074 vs 54 900) over the lifetime of the patient. CONCLUSIONS The recommendation to publicly fund AREDS supplements to category 3 patients would depend on the healthcare system willingness to pay. In contrast, initiating AREDS supplements in AREDS category 4 patients is both cost saving and more effective than no supplement use and should therefore be considered in public health policy.
Collapse
Affiliation(s)
- Aaron Y Lee
- Department of Ophthalmology, University of Washington, Seattle, Washington, USA
| | - Thomas Butt
- Institute of Ophthalmology, University College London, London, UK
| | - Emily Chew
- Division of Epidemiology and Clinical Research, National Institutes of Health, Bethesda, Maryland, USA
| | - Elvira Agron
- Division of Epidemiology and Clinical Applications, National Eye Institute, Bethesda, Maryland, USA
| | | | - Catherine A Egan
- Institute of Ophthalmology, University College London, London, UK.,Moorfields Eye Hospital, London, UK
| | - Cecilia S Lee
- Department of Ophthalmology, University of Washington, Seattle, Washington, USA
| | - Adnan Tufail
- Institute of Ophthalmology, University College London, London, UK.,Moorfields Eye Hospital, London, UK
| | | |
Collapse
|
18
|
Denniston AK, Chakravarthy U, Zhu H, Lee AY, Crabb DP, Tufail A, Bailey C, Akerele T, Al-Husainy S, Brand C, Downey L, Fitt A, Khan R, Kumar V, Lobo A, Mahmood S, Mandal K, Mckibbin M, Menon G, Natha S, Ong JM, Tsaloumas MD, Varma A, Wilkinson E, Johnston RL, Egan CA. The UK Diabetic Retinopathy Electronic Medical Record (UK DR EMR) Users Group, Report 2: real-world data for the impact of cataract surgery on diabetic macular oedema. Br J Ophthalmol 2017; 101:1673-1678. [PMID: 28487377 DOI: 10.1136/bjophthalmol-2016-309838] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Revised: 03/14/2017] [Accepted: 03/19/2017] [Indexed: 12/11/2022]
Abstract
AIM To assess the rate of 'treatment-requiring diabetic macular oedema (DMO)' in eyes for the two years before and after cataract surgery. METHODS Multicentre national diabetic retinopathy (DR) database study with anonymised data extraction across 19 centres from an electronic medical record system. INCLUSION CRITERIA eyes undergoing cataract surgery in patients with diabetes with no history of DMO prior to study start. The minimum dataset included: age, visual acuity (all time-points), injection episodes, timing of cataract surgery and ETDRS grading of retinopathy and maculopathy. MAIN OUTCOME MEASURE rate of developing first episode of treatment-requiring DMO in relation to timing of cataract surgery in the same eye. RESULTS 4850 eyes met the inclusion criteria. The rate of developing treatment-requiring DMO in this cohort was 2.9% in the year prior to surgery versus 5.3% in the year after surgery (p<0.01). The risk of 'treatment-requiring DMO' increased sharply after surgery, peaking in the 3-6 months' period (annualised rates of 5.2%, 6.8%, 5.6% and 4.0% for the 0-3, 3-6, 6-9 and 9-12 months' post-operative time periods respectively). Risk was associated with pre-operative grade of retinopathy: risk of DMO in the first year post-operatively being 1.0% (no DR pre-operatively), 5.4% (mild non-proliferative diabetic retinopathy; NPDR), 10.0% (moderate NPDR), 13.1% (severe NPDR) and 4.9% (PDR) (p<0.01). CONCLUSIONS This large real-world study demonstrates that the rate of developing treatment-requiring DMO increases sharply in the year after cataract surgery for all grades of retinopathy, peaking in the 3-6 months' postoperative period. Patients with moderate and severe NPDR are at particularly high risk.
Collapse
Affiliation(s)
- Alastair K Denniston
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.,The NIHR Biomedical Research Centre at Moorfields Eye Hospital NHSFT and UCL Institute for Ophthalmology, London, UK
| | | | | | - Aaron Y Lee
- Department of Ophthalmology, University of Washington, Seattle, USA
| | | | - Adnan Tufail
- The NIHR Biomedical Research Centre at Moorfields Eye Hospital NHSFT and UCL Institute for Ophthalmology, London, UK
| | - Clare Bailey
- Bristol Eye Hospital, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Toks Akerele
- Department of Ophthalmology, Hinchingbrooke Health Care NHS Trust, Huntingdon, UK
| | - Sahar Al-Husainy
- Department of Ophthalmology, Heart of England NHS Foundation Trust, Birmingham, UK
| | - Christopher Brand
- Department of Ophthalmology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Louise Downey
- Department of Ophthalmology, Hull Royal Infirmary, Hull, UK
| | - Alan Fitt
- Department of Ophthalmology, Peterborough and Stamford Hospitals NHS Foundation Trust, Peterborough, UK
| | - Rehna Khan
- Department of Ophthalmology, Calderdale and Huddersfield NHS Foundation Trust, Huddersfield, UK
| | - Vineeth Kumar
- Department of Ophthalmology, Wirral University Teaching Hospital NHS Foundation Trust, Wirral, UK
| | - Aires Lobo
- Moorfields Eye Unit, Bedford Hospitals NHS Trust, Bedford, UK
| | | | - Kaveri Mandal
- Department of Ophthalmology, Warrington and Halton Hospitals NHS Foundation Trust, Warrington, UK
| | - Martin Mckibbin
- Department of Ophthalmology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Geeta Menon
- Department of Ophthalmology, Frimley Park Hospital, Frimley, UK
| | - Salim Natha
- Department of Ophthalmology, Wrightington, Wigan and Leigh NHS Foundation Trust, Wigan, UK
| | - Jong Min Ong
- Department of Ophthalmology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Marie D Tsaloumas
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Atul Varma
- Department of Ophthalmology, Mid Yorkshire Hospitals NHS Trust, Yorkshire, UK
| | - Elizabeth Wilkinson
- Department of Ophthalmology, Northern Devon Healthcare NHS Trust, Barnstaple, UK
| | | | - Catherine A Egan
- The NIHR Biomedical Research Centre at Moorfields Eye Hospital NHSFT and UCL Institute for Ophthalmology, London, UK
| | | |
Collapse
|
19
|
Lee AY, Lee CS, Egan CA, Bailey C, Johnston RL, Natha S, Hamilton R, Khan R, Al-Husainy S, Brand C, Akerele T, Mckibbin M, Downey L, Tufail A. UK AMD/DR EMR REPORT IX: comparative effectiveness of predominantly as needed (PRN) ranibizumab versus continuous aflibercept in UK clinical practice. Br J Ophthalmol 2017; 101:1683-1688. [PMID: 28478396 DOI: 10.1136/bjophthalmol-2016-309818] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Revised: 03/07/2017] [Accepted: 04/06/2017] [Indexed: 12/27/2022]
Abstract
AIMS To compare the effectiveness of continuous aflibercept versus pro re nata (PRN) ranibizumab therapy for neovascular age-related macular degeneration (nAMD). METHODS Multicentre, national electronic medical record (EMR) study on treatment naive nAMD eyes undergoing PRN ranibizumab or continuous (fixed or treat and extend (F/TE)) aflibercept from 21 UK hospitals. Anonymised data were extracted, and eyes were matched on age, gender, starting visual acuity (VA) and year of starting treatment. Primary outcome was change in vision at 1 year. RESULTS 1884 eyes (942 eyes in each group) were included. At year 1, patients on PRN ranibizumab gained 1.6 ETDRS (Early Treatment Diabetic Retinopathy Study) letters (95% CI 0.5 to 2.7, p=0.004), while patients on F/TE aflibercept gained 6.1 letters (95% CI 5.1 to 7.1, p=2.2e-16). Change in vision at 1 year of the F/TE aflibercept group was 4.1 letters higher (95% CI 2.5 to 5.8, p=1.3e-06) compared with the PRN ranibizumab group after adjusting for age, starting VA, gender and year of starting therapy. The F/TE aflibercept group had significantly more injections compared with the PRN ranibizumab group (7.0 vs 5.8, p<2.2e-16), but required less clinic visits than the PRN ranibizumab group (10.8 vs 9.0, p<2.2e-16). Cost-effectiveness analysis showed an incremental cost-effectiveness ratio of 58 047.14 GBP/quality-adjusted life year for continuous aflibercept over PRN ranibizumab. CONCLUSION Aflibercept achieved greater VA gains at 1 year than ranibizumab. The observed VA differences are small and likely to be related to more frequent treatment with aflibercept, suggesting that ranibizumab should also be delivered by F/TE posology.
Collapse
Affiliation(s)
- Aaron Y Lee
- Department of Ophthalmology, University of Washington, Seattle, Washington, USA.,Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Cecilia S Lee
- Department of Ophthalmology, University of Washington, Seattle, Washington, USA
| | - Catherine A Egan
- UCL Institute of Ophthalmology, London, UK.,The NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation TrustLondonUK, London, UK
| | | | | | - Salim Natha
- Wrightington, Wigan and Leigh NHS Foundation Trust, Lancashire, UK
| | | | - Rehna Khan
- Calderdale and Huddersfield NHS Foundation Trust, Huddersfield, UK
| | | | | | - Toks Akerele
- Hinchingbrooke Health Care NHS Trust, Huntingdon, UK
| | | | - Louise Downey
- Hull and East Yorkshire Hospitals NHS Foundation Trust, Hull, UK
| | - Adnan Tufail
- UCL Institute of Ophthalmology, London, UK.,The NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation TrustLondonUK, London, UK
| |
Collapse
|
20
|
Scerri TS, Quaglieri A, Cai C, Zernant J, Matsunami N, Baird L, Scheppke L, Bonelli R, Yannuzzi LA, Friedlander M, Egan CA, Fruttiger M, Leppert M, Allikmets R, Bahlo M. Genome-wide analyses identify common variants associated with macular telangiectasia type 2. Nat Genet 2017; 49:559-567. [DOI: 10.1038/ng.3799] [Citation(s) in RCA: 81] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Accepted: 01/31/2017] [Indexed: 02/07/2023]
|
21
|
Okada M, Cardoso JN, Sim D, Egan CA, Ahmed S, Tufail A. Multimodal retinal imaging in the diagnosis of intraretinal microvascular abnormality. Expert Review of Ophthalmology 2016. [DOI: 10.1080/17469899.2016.1251310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
22
|
Mehta H, Müller S, Egan CA, Degli Esposti S, Tufail A, Sim DA, Holz FG, Browning AC, Amoaku WM, Charbel Issa P, Gillies MC. Natural history and effect of therapeutic interventions on subretinal fluid causing foveal detachment in macular telangiectasia type 2. Br J Ophthalmol 2016; 101:955-959. [PMID: 27793821 DOI: 10.1136/bjophthalmol-2016-309237] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Revised: 09/17/2016] [Accepted: 10/09/2016] [Indexed: 11/03/2022]
Abstract
AIM To report the natural history of subretinal fluid (SRF) causing foveal detachment in macular telangiectasia type 2 (MacTel) and our experience of therapeutic intervention with intravitreal steroids or antivascular endothelial growth factor inhibitor (anti-VEGF) agents in some cases. METHODS Retrospective case series. Three of the MacTel study's largest registries were searched to identify eyes with foveal detachment. RESULTS We identified 7 eyes from 6 exclusively female patients. The prevalence of foveal detachment was low, present in 1.4% of the assessed MacTel population. Age at presentation ranged from 50 to 66 years. Follow-up ranged from 2 to 8 years. There was late-phase leakage on fluorescein angiography from what was presumed to be ectatic capillaries. The SRF fluctuated without a rapid decline in visual acuity in cases that were not treated. When they were, intravitreal anti-VEGF and steroid therapy in general reduced SRF, at least temporarily, but did not halt the gradual long-term decrease in visual acuity. In one case, optical coherence tomography angiography showed significant reduction in the extent of the predominantly deep intraretinal vascular complex 1 month after anti-VEGF therapy. DISCUSSION AND CONCLUSIONS As the natural history of this unusual MacTel phenotype is not characterised by rapid visual decline, intervention with intravitreal anti-VEGF or steroid therapy may not be necessary.
Collapse
Affiliation(s)
- Hemal Mehta
- Macular Research Group, Save Sight Institute, University of Sydney, Sydney, Australia.,Medical Retina Department, Moorfields Eye Hospital NHS Trust, London, UK
| | - Simone Müller
- Department of Ophthalmology, University of Bonn, Bonn, Germany
| | - Catherine A Egan
- Medical Retina Department, Moorfields Eye Hospital NHS Trust, London, UK
| | | | - Adnan Tufail
- Medical Retina Department, Moorfields Eye Hospital NHS Trust, London, UK
| | - Dawn A Sim
- Medical Retina Department, Moorfields Eye Hospital NHS Trust, London, UK
| | - Frank G Holz
- Department of Ophthalmology, University of Bonn, Bonn, Germany
| | - Andrew C Browning
- Division of Ophthalmology and Visual Sciences, University of Nottingham, Queen's Medical Centre, UK
| | - Winfried M Amoaku
- Division of Ophthalmology and Visual Sciences, University of Nottingham, Queen's Medical Centre, UK
| | | | - Mark C Gillies
- Macular Research Group, Save Sight Institute, University of Sydney, Sydney, Australia
| |
Collapse
|
23
|
Powner MB, Sim DA, Zhu M, Nobre-Cardoso J, Jones R, Syed A, Chang AA, Keane PA, Tufail A, Egan CA, Fruttiger M. Evaluation of Nonperfused Retinal Vessels in Ischemic Retinopathy. Invest Ophthalmol Vis Sci 2016; 57:5031-5037. [PMID: 27661854 DOI: 10.1167/iovs.16-20007] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose Retinal ischemia has been traditionally assessed by fluorescein angiography, visualizing perfused vessels. However, this method does not provide any information about nonperfused vessels, and although it is often assumed that vessels in ischemic areas regress, we know little about how nonperfused retinal vessels change over time. Here, we aim to learn more about the long-term fate of nonperfused vessels in the retinal vasculature. Methods Optical coherence tomography (OCT) was used to visualize perfusion as well as structural properties of the retinal vasculature in patients suffering from retinal vascular occlusions. In addition, postmortem tissue from a patient with long standing (6 years) central retinal vein occlusion (CRVO) was investigated, using immunohistochemistry on whole-mount retina and paraffin sections to visualize blood vessel components. Results Comparing OCT angiography with enface OCT images revealed that in ischemic areas of the retina, nonperfused, larger vessels could be detected as hyperreflective structures in enface OCT images. Furthermore, analysis of a postmortem tissue sample from a CRVO patient with a large nonperfused region in the macula, revealed preservation of the basement membrane from all retinal vessels, including nonperfused, acellular vessels of all calibers. Conclusions Our data suggests long-term preservation of vascular basement membrane in ischemic retina. This has implications for therapeutic approaches aiming to alleviate retinal ischemia via the regeneration of damaged vessels.
Collapse
Affiliation(s)
- Michael B Powner
- UCL Institute of Ophthalmology, University College London, London, United Kingdom 2Division of Optometry and Visual Science, School of Health Sciences, City University London, London, United Kingdom
| | - Dawn A Sim
- UCL Institute of Ophthalmology, University College London, London, United Kingdom 3Moorfields Eye Hospital, London, United Kingdom
| | - Meidong Zhu
- Save Sight Institute, University of Sydney, Sydney, Australia 5Lions New South Wales Eye Bank, Sydney and Sydney Eye Hospital, Sydney, Australia
| | | | - Ryan Jones
- UCL Institute of Ophthalmology, University College London, London, United Kingdom
| | - Adil Syed
- Save Sight Institute, University of Sydney, Sydney, Australia 6Sydney Institute of Vision Science, Sydney, Australia
| | - Andrew A Chang
- Save Sight Institute, University of Sydney, Sydney, Australia 6Sydney Institute of Vision Science, Sydney, Australia
| | - Pearse A Keane
- UCL Institute of Ophthalmology, University College London, London, United Kingdom 3Moorfields Eye Hospital, London, United Kingdom
| | - Adnan Tufail
- UCL Institute of Ophthalmology, University College London, London, United Kingdom 3Moorfields Eye Hospital, London, United Kingdom
| | - Catherine A Egan
- UCL Institute of Ophthalmology, University College London, London, United Kingdom 3Moorfields Eye Hospital, London, United Kingdom
| | - Marcus Fruttiger
- UCL Institute of Ophthalmology, University College London, London, United Kingdom
| |
Collapse
|
24
|
Bradley PD, Sim DA, Keane PA, Cardoso J, Agrawal R, Tufail A, Egan CA. The Evaluation of Diabetic Macular Ischemia Using Optical Coherence Tomography Angiography. Invest Ophthalmol Vis Sci 2016; 57:626-31. [PMID: 26903223 DOI: 10.1167/iovs.15-18034] [Citation(s) in RCA: 82] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
PURPOSE The purpose of this study was to compare optical coherence tomography (OCT) angiography to standard fluorescein angiography (FA) in the grading of diabetic macular ischemia. METHODS In our study, OCT angiography and traditional FA images were acquired from 24 diabetic patients. The level of diabetic macular ischemia in the superficial capillary plexus was graded with standard Early Treatment Diabetic Retinopathy Study (ETDRS) protocols and a comparison between conventional FA and OCT angiography was performed. The deep vascular plexus and choriocapillaris were also graded for macular ischemia. Additionally, flow indices were analyzed for all OCT angiography images. RESULTS We identified moderate agreement between diabetic macular ischemia grades for conventional FA and OCT angiography (weighted κ of 0.53 and 0.41). In addition, the intergrader agreement for the superficial, deep, and choriocapillaris scores was substantial (weighted κ of 0.65, 0.61, and 0.65, respectively). Finally, the parafoveal flow indices were shown to have a statistically significant relationship with diabetic macular ischemia grades for the superficial capillary plexus (P = 0.04) and choriocapillaris (P = 0.036), with a trend toward significance for the deep capillary plexus (P = 0.13). CONCLUSIONS We demonstrated moderate agreement between diabetic macular ischemia grading results for OCT angiography and conventional FA using standard ETDRS protocols. We also showed that OCT angiography images could be graded for diabetic macular ischemia with substantial intergrader agreement.
Collapse
Affiliation(s)
| | - Dawn A Sim
- Moorfields Eye Hospital NHS Foundation Trust London, United Kingdom
| | - Pearse A Keane
- Moorfields Eye Hospital NHS Foundation Trust London, United Kingdom
| | - João Cardoso
- Moorfields Eye Hospital NHS Foundation Trust London, United Kingdom 2Hospital Garcia de Orta E.P.E., Almada, Portugal
| | - Rupesh Agrawal
- Moorfields Eye Hospital NHS Foundation Trust London, United Kingdom
| | - Adnan Tufail
- Moorfields Eye Hospital NHS Foundation Trust London, United Kingdom
| | - Catherine A Egan
- Moorfields Eye Hospital NHS Foundation Trust London, United Kingdom
| |
Collapse
|
25
|
Negretti GS, Amin R, Webster L, Egan CA. Does delay in referral of proliferative diabetic retinopathy from the diabetic eye screening programme lead to visual loss? Eye (Lond) 2016; 30:873-6. [PMID: 27055673 DOI: 10.1038/eye.2016.56] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Accepted: 02/02/2016] [Indexed: 11/09/2022] Open
Abstract
AimsTo ascertain the effect on visual acuity (VA) of a delay in Hospital Eye Service (HES) consultation for patients referred with proliferative diabetic retinopathy (PDR; R3) from the Diabetic Eye Screening Programme (DESP).MethodsAll patients referred to Moorfields Eye Hospital from DESP between April and December 2013 with a referral diagnosis of PDR in at least one eye were eligible. Screening programme VA was compared with VA at first HES appointment and final follow-up appointment. Reasons for any VA loss were noted.ResultsA total of 86 patients were included. Of these, 28 (33%) were seen in more than 4 weeks after their DESP referral. At first HES appointment, 39 (45%) patients were graded as having active PDR in at least one eye. Delay in referral did not significantly predict the likelihood of vision loss in all patients referred (χ(2), P=0.49) or in just those patients with a definitive HES diagnosis of active PDR (χ(2), P=1.00). In only 3 patients with active PDR was a delay in presentation thought to have led directly to VA loss.ConclusionsThere may be minimal short-term visual consequence in several weeks of delayed referral for many patients with a diagnosis of R3. However, the national guidance remains important. This is due to the occasional patient at very high risk of vision loss and the many gains for the patients in terms of time to properly assess medical and ocular conditions and counsel and consent them for treatment where necessary.
Collapse
Affiliation(s)
- G S Negretti
- Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - R Amin
- Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - L Webster
- Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - C A Egan
- Moorfields Eye Hospital NHS Foundation Trust, London, UK
| |
Collapse
|
26
|
Madhusudhana KC, Lee AY, Keane PA, Chakravarthy U, Johnston RL, Egan CA, Sim D, Zarranz-Ventura J, Tufail A, McKibbin M. UK Neovascular Age-Related Macular Degeneration Database. Report 6: time to retreatment after a pause in therapy. Outcomes from 92 976 intravitreal ranibizumab injections. Br J Ophthalmol 2016; 100:1617-1622. [PMID: 27030276 DOI: 10.1136/bjophthalmol-2015-308077] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2015] [Revised: 02/11/2016] [Accepted: 03/10/2016] [Indexed: 11/04/2022]
Abstract
BACKGROUND/AIMS To study the time to retreatment in eyes with neovascular age-related macular degeneration (nAMD) that had been treatment-free for intervals of 3 months, 6 months, 9 months and 12 months during the maintenance phase of ranibizumab therapy within the UK National Health Service. METHODS In this multicentre national nAMD database study, structured data were collected from 14 centres (involving 12 951 eyes receiving 92 976 ranibizumab injections). Patients were treated with three fixed, monthly injections in a loading phase of treatment, followed by a pro re nata retreatment regimen in a maintenance phase. Eyes with a treatment-free interval (TFI) of 3 months, 6 months, 9 months or 12 months in the maintenance phase were identified and the time to retreatment after these TFIs was determined. RESULTS The time to retreatment for the 20th and 50th centiles was 0.58/2.54 months after a 3-month TFI, 2.07/9.62 months after a 6-month TFI, 3.69/15.84 months after a 9-month TFI and 5.90/22.49 months after a 12-month TFI. Following a TFI of 3 months, 6 months, 9 months and 12 months, 68%, 44%, 31% and 21% of eyes required retreatments after an additional 6 months of follow-up, respectively. Similarly, after 12 months of follow-up, 77%, 56%, 43% and 34% of these eyes required retreatment. CONCLUSIONS This study provides times to retreatment in eyes with nAMD that have been treatment-free for intervals of 3-12 months and demonstrates the likelihood of repeat therapy within the next year, even after a TFI of 12 months. These outcomes can help plan appropriate follow-up intervals for patients who have been treatment-free for intervals of up to 12 months.
Collapse
Affiliation(s)
| | - Aaron Y Lee
- NIHR Biomedical Research Centre at Moorfields Eye Hospital and the Institute of Ophthalmology, University College London, London, UK.,Medical Retina Service, Moorfields Eye Hospital NHS Foundation Trust, London, UK.,Department of Ophthalmology, University of Washington, Seattle, Washington, USA
| | - Pearse A Keane
- NIHR Biomedical Research Centre at Moorfields Eye Hospital and the Institute of Ophthalmology, University College London, London, UK.,Medical Retina Service, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Usha Chakravarthy
- Centre for Vascular & Vision Sciences, Queen's University, Belfast, UK
| | - Robert L Johnston
- Medical Retina Service, Gloucestershire Hospitals NHS Foundation Trust, Cheltenham General Hospital, Cheltenham, UK
| | - Catherine A Egan
- NIHR Biomedical Research Centre at Moorfields Eye Hospital and the Institute of Ophthalmology, University College London, London, UK.,Medical Retina Service, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Dawn Sim
- NIHR Biomedical Research Centre at Moorfields Eye Hospital and the Institute of Ophthalmology, University College London, London, UK.,Medical Retina Service, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Javier Zarranz-Ventura
- NIHR Biomedical Research Centre at Moorfields Eye Hospital and the Institute of Ophthalmology, University College London, London, UK.,Medical Retina Service, Moorfields Eye Hospital NHS Foundation Trust, London, UK.,Medical Retina Service, Gloucestershire Hospitals NHS Foundation Trust, Cheltenham General Hospital, Cheltenham, UK
| | - Adnan Tufail
- NIHR Biomedical Research Centre at Moorfields Eye Hospital and the Institute of Ophthalmology, University College London, London, UK.,Medical Retina Service, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Martin McKibbin
- Eye Clinic, St James's University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | | |
Collapse
|
27
|
Shah N, Dakin SC, Dobinson S, Tufail A, Egan CA, Anderson RS. Visual acuity loss in patients with age-related macular degeneration measured using a novel high-pass letter chart. Br J Ophthalmol 2016; 100:1346-52. [PMID: 26846435 DOI: 10.1136/bjophthalmol-2015-307375] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Accepted: 12/21/2015] [Indexed: 11/04/2022]
Abstract
BACKGROUND/AIMS Conventional Logarithm of the Minimum Angle of Resolution (logMAR) acuity is the current gold standard for assessing visual function in age-related macular degeneration (AMD). However, visual acuity (VA) often remains 'normal' when measured with these charts, even with advanced retinal changes. We wished to investigate how VA measurements with the Moorfields Acuity Chart (MAC), which employs high-pass filtered letters, compares to conventional letter charts in subjects with AMD. METHODS Monocular best-corrected VA measurements and test-retest variability (TRV) were compared for conventional and MAC charts in 38 normal observers (mean age 52.1 years) and 80 patients (mean age 80.6 years) with varying degrees of acuity loss owing to AMD. Methods of Bland-Altman and ordinary least-squares regression were employed for data analysis. RESULTS A proportional bias was confirmed between conventional and MAC measurements (r(2)=0.133, p=0.001) such that MAC acuity was -0.45 logMAR 'worse' at the 0.00 logMAR acuity level, but only -0.26 logMAR 'worse' at the 1.00 logMAR level. The mean bias was much smaller in the normal subject group (-0.16 logMAR). Similar TRV (ranging from ±0.09 to ±0.12 logMAR) was found for both charts in both subject groups. CONCLUSIONS VA measurements with the MAC chart appear to be more sensitive to functional loss in AMD compared with conventional letter charts, with similar TRV. Simulations indicate this may be because the high-pass filtered letters are more vulnerable to undersampling as a result of retinal cell loss in the disease process.
Collapse
Affiliation(s)
- Nilpa Shah
- NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
| | - Steven C Dakin
- NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK Department of Optometry & Vision Science, University of Auckland, Auckland, New Zealand
| | - Sarah Dobinson
- NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
| | - Adnan Tufail
- NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
| | - Catherine A Egan
- NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
| | - Roger S Anderson
- NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK Vision Science Research Group, School of Biomedical Sciences, University of Ulster at Coleraine, N Ireland, UK
| |
Collapse
|
28
|
Sim DA, Mitry D, Alexander P, Mapani A, Goverdhan S, Aslam T, Tufail A, Egan CA, Keane PA. The Evolution of Teleophthalmology Programs in the United Kingdom: Beyond Diabetic Retinopathy Screening. J Diabetes Sci Technol 2016; 10:308-17. [PMID: 26830492 PMCID: PMC4773982 DOI: 10.1177/1932296816629983] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Modern ophthalmic practice in the United Kingdom is faced by the challenges of an aging population, increasing prevalence of systemic pathologies with ophthalmic manifestations, and emergent treatments that are revolutionary but dependent on timely monitoring and diagnosis. This represents a huge strain not only on diagnostic services but also outpatient management and surveillance capacity. There is an urgent need for newer means of managing this surge in demand and the socioeconomic burden it places on the health care system. Concurrently, there have been exponential increases in computing power, expansions in the strength and ubiquity of communications technologies, and developments in imaging capabilities. Advances in imaging have been not only in terms of resolution, but also in terms of anatomical coverage, allowing new inferences to be made. In spite of this, image analysis techniques are still currently superseded by expert ophthalmologist interpretation. Teleophthalmology is therefore currently perfectly placed to face this urgent and immediate challenge of provision of optimal and expert care to remote and multiple patients over widespread geographical areas. This article reviews teleophthalmology programs currently deployed in the United Kingdom, focusing on diabetic eye care but also discussing glaucoma, emergency eye care, and other retinal diseases. We examined current programs and levels of evidence for their utility, and explored the relationships between screening, teleophthalmology, disease detection, and monitoring before discussing aspects of health economics pertinent to diabetic eye care. The use of teleophthalmology presents an immense opportunity to manage the steadily increasing demand for eye care, but challenges remain in the delivery of practical, viable, and clinically proven solutions.
Collapse
Affiliation(s)
- Dawn A Sim
- NIHR Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust, London, UK Moorfields South, Croydon University Hospital, London, UK Moorfields South, St George's Hospital, London, UK University College London, Institute of Ophthalmology, London, UK
| | - Danny Mitry
- NIHR Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Philip Alexander
- NIHR Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Adam Mapani
- NIHR Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Srini Goverdhan
- University of Southampton, Southampton Eye Unit, Southampton, UK
| | - Tariq Aslam
- Manchester University, Manchester Royal Eye Hospital, Manchester, UK
| | - Adnan Tufail
- NIHR Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust, London, UK University College London, Institute of Ophthalmology, London, UK
| | - Catherine A Egan
- NIHR Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust, London, UK Moorfields South, St George's Hospital, London, UK University College London, Institute of Ophthalmology, London, UK
| | - Pearse A Keane
- NIHR Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust, London, UK University College London, Institute of Ophthalmology, London, UK
| |
Collapse
|
29
|
Ang M, Cai Y, MacPhee B, Sim DA, Keane PA, Sng CCA, Egan CA, Tufail A, Larkin DF, Wilkins MR. Optical coherence tomography angiography and indocyanine green angiography for corneal vascularisation. Br J Ophthalmol 2016; 100:1557-1563. [DOI: 10.1136/bjophthalmol-2015-307706] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Revised: 12/01/2015] [Accepted: 01/10/2016] [Indexed: 11/03/2022]
|
30
|
Ang M, Sim DA, Keane PA, Sng CC, Egan CA, Tufail A, Wilkins MR. Optical Coherence Tomography Angiography for Anterior Segment Vasculature Imaging. Ophthalmology 2015; 122:1740-7. [DOI: 10.1016/j.ophtha.2015.05.017] [Citation(s) in RCA: 86] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2015] [Revised: 05/09/2015] [Accepted: 05/12/2015] [Indexed: 02/01/2023] Open
|
31
|
Ang M, Cai Y, Shahipasand S, Sim DA, Keane PA, Sng CCA, Egan CA, Tufail A, Wilkins MR. En face optical coherence tomography angiography for corneal neovascularisation. Br J Ophthalmol 2015; 100:616-21. [DOI: 10.1136/bjophthalmol-2015-307338] [Citation(s) in RCA: 68] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Accepted: 08/04/2015] [Indexed: 11/04/2022]
|
32
|
Sim DA, Chu CJ, Selvam S, Powner MB, Liyanage S, Copland DA, Keane PA, Tufail A, Egan CA, Bainbridge JWB, Lee RW, Dick AD, Fruttiger M. A simple method for in vivo labelling of infiltrating leukocytes in the mouse retina using indocyanine green dye. Dis Model Mech 2015; 8:1479-87. [PMID: 26398933 PMCID: PMC4631782 DOI: 10.1242/dmm.019018] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2015] [Accepted: 08/09/2015] [Indexed: 01/20/2023] Open
Abstract
We have developed a method to label and image myeloid cells infiltrating the mouse retina and choroid in vivo, using a single depot injection of indocyanine green dye (ICG). This was demonstrated using the following ocular models of inflammation and angiogenesis: endotoxin-induced uveitis, experimental autoimmune uveoretinitis and laser-induced choroidal neovascularization model. A near-infrared scanning ophthalmoscope was used for in vivo imaging of the eye, and flow cytometry was used on blood and spleen to assess the number and phenotype of labelled cells. ICG was administered 72 h before the induction of inflammation to ensure clearance from the systemic circulation. We found that in vivo intravenous administration failed to label any leukocytes, whereas depot injection, either intraperitoneal or subcutaneous, was successful in labelling leukocytes infiltrating into the retina. Progression of inflammation in the retina could be traced over a period of 14 days following a single depot injection of ICG. Additionally, bright-field microscopy, spectrophotometry and flow cytometric analysis suggest that the predominant population of cells stained by ICG are circulating myeloid cells. The translation of this approach into clinical practice would enable visualization of immune cells in situ. This will not only provide a greater understanding of pathogenesis, monitoring and assessment of therapy in many human ocular diseases but might also open the ability to image immunity live for neurodegenerative disorders, cardiovascular disease and systemic immune-mediated disorders. Summary: We show here that peripheral leukocytes can be labelled with ICG in vivo and then directly imaged as they invade the retina after inflammatory stimuli.
Collapse
Affiliation(s)
- Dawn A Sim
- NIHR Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust, London EC1V 2PD, UK University College London, Institute of Ophthalmology, London EC1V 9EL, UK
| | - Colin J Chu
- University College London, Institute of Ophthalmology, London EC1V 9EL, UK Academic Unit of Ophthalmology, School of Clinical Sciences, University of Bristol, Bristol BS8 1TD, UK
| | - Senthil Selvam
- NIHR Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust, London EC1V 2PD, UK University College London, Institute of Ophthalmology, London EC1V 9EL, UK
| | - Michael B Powner
- University College London, Institute of Ophthalmology, London EC1V 9EL, UK
| | - Sidath Liyanage
- University College London, Institute of Ophthalmology, London EC1V 9EL, UK
| | - David A Copland
- Academic Unit of Ophthalmology, School of Clinical Sciences, University of Bristol, Bristol BS8 1TD, UK
| | - Pearse A Keane
- NIHR Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust, London EC1V 2PD, UK University College London, Institute of Ophthalmology, London EC1V 9EL, UK
| | - Adnan Tufail
- NIHR Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust, London EC1V 2PD, UK University College London, Institute of Ophthalmology, London EC1V 9EL, UK
| | - Catherine A Egan
- NIHR Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust, London EC1V 2PD, UK
| | - James W B Bainbridge
- NIHR Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust, London EC1V 2PD, UK University College London, Institute of Ophthalmology, London EC1V 9EL, UK
| | - Richard W Lee
- NIHR Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust, London EC1V 2PD, UK Academic Unit of Ophthalmology, School of Clinical Sciences, University of Bristol, Bristol BS8 1TD, UK
| | - Andrew D Dick
- NIHR Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust, London EC1V 2PD, UK Academic Unit of Ophthalmology, School of Clinical Sciences, University of Bristol, Bristol BS8 1TD, UK
| | - Marcus Fruttiger
- University College London, Institute of Ophthalmology, London EC1V 9EL, UK
| |
Collapse
|
33
|
Mehta H, Sim DA, Keane PA, Zarranz-Ventura J, Gallagher K, Egan CA, Westcott M, Lee RWJ, Tufail A, Pavesio CE. Structural changes of the choroid in sarcoid- and tuberculosis-related granulomatous uveitis. Eye (Lond) 2015; 29:1060-8. [PMID: 26021867 DOI: 10.1038/eye.2015.65] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2014] [Accepted: 03/21/2015] [Indexed: 12/31/2022] Open
Abstract
AIM The aim of this study is to characterise the choroidal features of patients diagnosed with sarcoid- and tuberculosis (TB)-associated granulomatous uveitis using spectral domain optical coherence tomography (OCT). METHODS Twenty-seven patients (27 eyes) diagnosed with sarcoid- (13 eyes) and TB (14 eyes)-related uveitis were included in this retrospective, cross-sectional study. Over a six-month period, patients diagnosed with sarcoid and TB granulomatous uveitis were scanned using enhanced depth imaging OCT. Clinical and demographical characteristics were recorded, including the method of diagnosis, disease activity, site of inflammation (anterior or posterior), treatments, and visual acuity (VA). Manual segmentation of the choroidal layers was performed using custom image analysis software. RESULTS The main outcome measure was OCT-derived thickness measurements of the choroid and choroidal sublayers (Haller's large vessel and Sattler's medium vessel layers) at the macula region. The ratio of Haller's large vessel to Sattler's medium vessel layer was significantly different at the total macula circle in eyes diagnosed with TB uveitis (1.47 (=140.71/95.72 μm)) compared with sarcoid uveitis (1.07 (=137.70/128.69 μm)) (P=0.001). A thinner choroid was observed in eyes with a VA ≥0.3 LogMAR (Snellen 6/12; 198.1 μm (interquartile range (IQR)=147.0-253.4 μm) compared with those with VA <0.3 LogMAR (292.4 μm (IQR=240.1-347.6 μm)) at the total macula circle (P=0.004). At the foveal central subfield, the median choroidal thickness was 336.8 μm (IQR=272.3-375.4 μm) in active compared with 239.3 μm (IQR=195.3-330.9 μm) in quiescent disease (P=0.04). CONCLUSION A disproportionately enlarged Sattler's layer may indicate a diagnosis of sarcoid-related uveitis, and choroidal thickening may be a feature of active granulomatous uveitis.
Collapse
Affiliation(s)
- H Mehta
- Medical Retina and Uveitis Service, Department of Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - D A Sim
- 1] NIHR Moorfields Biomedical Research Centre, London, UK [2] Institute of Ophthalmology, University London, London, UK
| | - P A Keane
- 1] NIHR Moorfields Biomedical Research Centre, London, UK [2] Institute of Ophthalmology, University London, London, UK
| | - J Zarranz-Ventura
- 1] Medical Retina and Uveitis Service, Department of Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust, London, UK [2] Vitreo-Retinal Service, Bristol Eye Hospital, Bristol, UK
| | - K Gallagher
- Medical Retina and Uveitis Service, Department of Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - C A Egan
- Medical Retina and Uveitis Service, Department of Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - M Westcott
- Medical Retina and Uveitis Service, Department of Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - R W J Lee
- 1] Medical Retina and Uveitis Service, Department of Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust, London, UK [2] NIHR Moorfields Biomedical Research Centre, London, UK [3] Institute of Ophthalmology, University London, London, UK [4] School of Clinical Sciences, University of Bristol, Bristol, UK
| | - A Tufail
- 1] Medical Retina and Uveitis Service, Department of Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust, London, UK [2] NIHR Moorfields Biomedical Research Centre, London, UK [3] Institute of Ophthalmology, University London, London, UK
| | - C E Pavesio
- 1] Medical Retina and Uveitis Service, Department of Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust, London, UK [2] NIHR Moorfields Biomedical Research Centre, London, UK
| |
Collapse
|
34
|
Abstract
There will be an estimated 552 million persons with diabetes globally by the year 2030. Over half of these individuals will develop diabetic retinopathy, representing a nearly insurmountable burden for providing diabetes eye care. Telemedicine programmes have the capability to distribute quality eye care to virtually any location and address the lack of access to ophthalmic services. In most programmes, there is currently a heavy reliance on specially trained retinal image graders, a resource in short supply worldwide. These factors necessitate an image grading automation process to increase the speed of retinal image evaluation while maintaining accuracy and cost effectiveness. Several automatic retinal image analysis systems designed for use in telemedicine have recently become commercially available. Such systems have the potential to substantially improve the manner by which diabetes eye care is delivered by providing automated real-time evaluation to expedite diagnosis and referral if required. Furthermore, integration with electronic medical records may allow a more accurate prognostication for individual patients and may provide predictive modelling of medical risk factors based on broad population data.
Collapse
Affiliation(s)
- Dawn A Sim
- Department of Ophthalmology, Harvard Medical School and Beetham Eye Institute, Joslin Diabetes Center, One Joslin Place, Boston, MA, 02215, USA
| | | | | | | | | | | |
Collapse
|
35
|
Liew G, Sim DA, Keane PA, Tan AG, Mitchell P, Wang JJ, Wong TY, Fruttiger M, Tufail A, Egan CA. Diabetic macular ischaemia is associated with narrower retinal arterioles in patients with type 2 diabetes. Acta Ophthalmol 2015; 93:e45-51. [PMID: 25613127 DOI: 10.1111/aos.12519] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2014] [Accepted: 07/03/2014] [Indexed: 11/30/2022]
Abstract
PURPOSE Diabetic macular ischaemia (DMI) is an important cause of visual loss in patients with diabetes, but its relationship to the larger retinal vessels is unknown. We examined whether retinal vessel calibre is related to DMI. METHODS Clinic-based case-control study of patients with type 2 diabetes. The presence and severity of DMI was assessed using Early Treatment Diabetic Retinopathy Study (ETDRS) protocols from fundus fluorescein angiographic (FFA) images. Custom software was used to quantify the greatest linear dimension and area of the foveal avascular zone (FAZ). Retinal vessel calibre was measured using a semi-automated software on fundus fluorescein images. RESULTS Of 53 patients examined, 18 (34%), 18 (34%) and 17 (32%) had no/mild, moderate and severe DMI, respectively. Persons with moderate or severe DMI had narrower mean retinal arteriolar calibre than persons with no/mild DMI (140.6 μm 95% confidence interval (CI) 134.7, 146.4 versus 150.7 μm, 95% CI 142.5, 158, p = 0.04). The association remained after multivariate adjustment for age, gender, previous panretinal photocoagulation, neovascularization at the disc and elsewhere and diabetic retinopathy severity. Increased FAZ size was also associated with narrower arteriolar calibre. Retinal venular calibre and arteriole to venule ratio (AVR) were not associated with DMI. CONCLUSIONS Retinal arteriolar narrowing was associated with moderate-to-severe macular ischaemia in eyes with diabetic retinopathy. This suggests that larger vessels other than capillaries may also be associated with DMI.
Collapse
Affiliation(s)
- Gerald Liew
- Moorfields Eye Hospital NHS Foundation Trust; London UK
- Center for Vision Research; Westmead Millenium Institute; University of Sydney; Sydney NSW Australia
| | - Dawn A. Sim
- Moorfields Eye Hospital NHS Foundation Trust; London UK
- Institute of Ophthalmology; University College London; London UK
| | - Pearse A. Keane
- Moorfields Eye Hospital NHS Foundation Trust; London UK
- Institute of Ophthalmology; University College London; London UK
| | - Ava G. Tan
- Center for Vision Research; Westmead Millenium Institute; University of Sydney; Sydney NSW Australia
| | - Paul Mitchell
- Center for Vision Research; Westmead Millenium Institute; University of Sydney; Sydney NSW Australia
| | - Jie Jin Wang
- Center for Vision Research; Westmead Millenium Institute; University of Sydney; Sydney NSW Australia
| | - Tien Y. Wong
- Singapore National Eye Center; Singapore Eye Research Institute; Yong Loo Lin School of Medicine; National University of Singapore; Singapore City Singapore
| | - Marcus Fruttiger
- Institute of Ophthalmology; University College London; London UK
| | - Adnan Tufail
- Moorfields Eye Hospital NHS Foundation Trust; London UK
- Institute of Ophthalmology; University College London; London UK
| | - Catherine A. Egan
- Moorfields Eye Hospital NHS Foundation Trust; London UK
- Institute of Ophthalmology; University College London; London UK
| |
Collapse
|
36
|
Lee CS, Lee AY, Sim DA, Keane PA, Mehta H, Zarranz-Ventura J, Fruttiger M, Egan CA, Tufail A. Reevaluating the definition of intraretinal microvascular abnormalities and neovascularization elsewhere in diabetic retinopathy using optical coherence tomography and fluorescein angiography. Am J Ophthalmol 2015; 159:101-10.e1. [PMID: 25284762 DOI: 10.1016/j.ajo.2014.09.041] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2014] [Revised: 09/24/2014] [Accepted: 09/25/2014] [Indexed: 01/27/2023]
Abstract
PURPOSE To evaluate the agreement between clinical examination, spectral-domain ocular coherence tomography (SD OCT), and fluorescein angiography (FA) in diagnosing intraretinal microvascular abnormality (IRMA) and neovascularization elsewhere (NVE) and define the SD OCT features that differentiate NVEs from IRMAs. DESIGN Retrospective study. METHODS Data were collected from 23 lesions from 8 diabetic patients, seen from July 2012 through October 2013 at Moorfields Eye Hospital, United Kingdom. Main outcomes were SD OCT features and FA leakage of IRMA and neovascular complex. The agreement between 3 evaluations was analyzed by Fleiss' kappa. RESULTS The following 5 SD OCT features significantly differentiated IRMAs from NVEs: (1) hyperreflective dots in superficial inner retina (P = .002); (2) the outpouching of internal limiting membrane (ILM) (P = .004); (3) the breach of ILM (P = .004); (4) the breach of posterior hyaloid (P = .0005); (5) hyperreflective dots in vitreous (P = .008). The agreement was moderate between 3 evaluations (κ = 0.48, P = 7.11 × 10(-5)) but substantial between clinical and SD OCT evaluation (κ = 0.72, P = .00055). There was no significant agreement between OCT evaluation and FA leakage (κ = 0.249, P = .232). CONCLUSIONS SD OCT will be a valuable adjunct in evaluating IRMA and NVE, since it can verify the histopathologic correlate. SD OCT provides subtle anatomic insights and may be more accurate than clinical examination or leakage on FA, our current method of diagnosing this important endpoint, which has implications in future trial design for proliferative diabetic retinopathy prevention.
Collapse
Affiliation(s)
- Cecilia S Lee
- Medical Retina Service, Moorfields Eye Hospital National Health Service Foundation Trust, London, United Kingdom
| | - Aaron Y Lee
- Medical Retina Service, Moorfields Eye Hospital National Health Service Foundation Trust, London, United Kingdom; University College London, Institute of Ophthalmology, London, United Kingdom
| | - Dawn A Sim
- National Institute for Health Research Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital National Health Service Foundation Trust, London, United Kingdom; University College London, Institute of Ophthalmology, London, United Kingdom
| | - Pearse A Keane
- Medical Retina Service, Moorfields Eye Hospital National Health Service Foundation Trust, London, United Kingdom; National Institute for Health Research Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital National Health Service Foundation Trust, London, United Kingdom; University College London, Institute of Ophthalmology, London, United Kingdom
| | - Hemal Mehta
- Medical Retina Service, Moorfields Eye Hospital National Health Service Foundation Trust, London, United Kingdom
| | - Javier Zarranz-Ventura
- National Institute for Health Research Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital National Health Service Foundation Trust, London, United Kingdom
| | - Marcus Fruttiger
- University College London, Institute of Ophthalmology, London, United Kingdom
| | - Catherine A Egan
- Medical Retina Service, Moorfields Eye Hospital National Health Service Foundation Trust, London, United Kingdom; National Institute for Health Research Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital National Health Service Foundation Trust, London, United Kingdom
| | - Adnan Tufail
- Medical Retina Service, Moorfields Eye Hospital National Health Service Foundation Trust, London, United Kingdom; National Institute for Health Research Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital National Health Service Foundation Trust, London, United Kingdom; University College London, Institute of Ophthalmology, London, United Kingdom.
| |
Collapse
|
37
|
Sim DA, Keane PA, Rajendram R, Karampelas M, Selvam S, Powner MB, Fruttiger M, Tufail A, Egan CA. Patterns of peripheral retinal and central macula ischemia in diabetic retinopathy as evaluated by ultra-widefield fluorescein angiography. Am J Ophthalmol 2014; 158:144-153.e1. [PMID: 24709807 DOI: 10.1016/j.ajo.2014.03.009] [Citation(s) in RCA: 97] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2014] [Revised: 03/20/2014] [Accepted: 03/20/2014] [Indexed: 12/16/2022]
Abstract
PURPOSE To investigate the association between peripheral and central ischemia in diabetic retinopathy. DESIGN Retrospective, cross-sectional. METHODS Consecutive ultra-widefield fluorescein angiography images were collected from patients with diabetes over a 12-month period. Parameters quantified include the foveal avascular zone (FAZ) area, peripheral ischemic index, peripheral leakage index, and central retinal thickness measurements, as well as visual acuity. The peripheral ischemia or leakage index was calculated as the area of capillary nonperfusion or leakage, expressed as a percentage of the total retinal area. RESULTS Forty-seven eyes of 47 patients were included. A moderate correlation was observed between the peripheral ischemia index and FAZ area (r = 0.49, P = .0001). A moderate correlation was also observed between the peripheral leakage index and FAZ area, but only in eyes that were laser naïve (r = 0.44, P = .02). A thinner retina was observed in eyes with macular ischemia (217 ± 81.8 μm vs 272 ± 36.0 μm) (P = .02), but not peripheral ischemia (258 ± 76.3 μm vs 276 ± 68.0 μm) (P = .24). The relationships between different patterns of peripheral and central macular pathology and visual acuity were evaluated in a step-wise multivariable regression model, and the variables that remained independently associated were age (r = 0.33, P = .03), FAZ area (r = 0.45, P = .02), and central retinal thickness (r = 0.38, P = .01), (R(2)-adjusted = 0.36). CONCLUSIONS Ultra-widefield fluorescein angiography provides an insight into the relationships between diabetic vascular complications in the retinal periphery and central macula. Although we observed relationships between ischemia and vascular leakage in the macula and periphery, it was only macular ischemia and retinal thinning that was independently associated with a reduced visual function.
Collapse
|
38
|
Comyn O, Sivaprasad S, Peto T, Neveu MM, Holder GE, Xing W, Bunce CV, Patel PJ, Egan CA, Bainbridge JW, Hykin PG. A randomized trial to assess functional and structural effects of ranibizumab versus laser in diabetic macular edema (the LUCIDATE study). Am J Ophthalmol 2014; 157:960-70. [PMID: 24531025 DOI: 10.1016/j.ajo.2014.02.019] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2013] [Revised: 02/05/2014] [Accepted: 02/05/2014] [Indexed: 11/19/2022]
Abstract
PURPOSE To compare the functional and structural effects of ranibizumab versus macular laser therapy in patients with center-involving diabetic macular edema. DESIGN Prospective, randomized, single-masked clinical trial. METHODS SETTING Single center. STUDY POPULATION Thirty-three eyes of 33 patients with center-involving diabetic macular edema, with best corrected visual acuity of 55 to 79 Early Treatment Diabetic Retinopathy Study letters at baseline, completing the 48-week study period. INTERVENTION Subjects were randomized 2:1 to 3 loading doses of ranibizumab then retreatment every 4 weeks as required; or macular laser therapy at baseline, repeated as required every 12 weeks. Exploratory Outcome Measures: Structural imaging studies included greatest linear dimension and area of foveal avascular zone, perifoveal capillary dropout grade, and presence of morphologic features of diabetic macular edema on Spectralis optical coherence tomography (Heidelberg Engineering GmbH, Heidelberg, Germany). Functional measures: Visual acuity, retinal sensitivity in the central 4 and 12 degrees on microperimetry, color contrast sensitivity protan and tritan thresholds, pattern and full-field electroretinogram amplitudes and implicit times, and multifocal electroretinogram amplitude distribution. These were reported at 12, 24, and 48 weeks. RESULTS Ranibizumab-treated subjects gained 6.0 vs 0.9 letters lost for laser, demonstrated improved tritan and protan color contrast thresholds, and improved retinal sensitivity. Electrophysiologic function also improved after ranibizumab therapy. No safety issues were evident. Better retinal thickness reduction and structural improvement in optical coherence tomography features of diabetic macular edema were seen with ranibizumab therapy than in the laser group. There was no evidence of progressive ischemia with ranibizumab therapy. CONCLUSIONS Ranibizumab therapy in the treatment of diabetic macular edema seems to improve retinal function and structure as demonstrated by this evaluation of different assessment methods.
Collapse
Affiliation(s)
- Oliver Comyn
- National Institute for Health Research Biomedical Research Centre at Moorfields Eye Hospital and University College London Institute of Ophthalmology, London, United Kingdom.
| | - Sobha Sivaprasad
- National Institute for Health Research Biomedical Research Centre at Moorfields Eye Hospital and University College London Institute of Ophthalmology, London, United Kingdom
| | - Tunde Peto
- National Institute for Health Research Biomedical Research Centre at Moorfields Eye Hospital and University College London Institute of Ophthalmology, London, United Kingdom; Reading Centre, Moorfields Eye Hospital, London, United Kingdom
| | - Magella M Neveu
- Department of Electrophysiology, Moorfields Eye Hospital, London, United Kingdom
| | - Graham E Holder
- Department of Electrophysiology, Moorfields Eye Hospital, London, United Kingdom
| | - Wen Xing
- National Institute for Health Research Biomedical Research Centre at Moorfields Eye Hospital and University College London Institute of Ophthalmology, London, United Kingdom
| | - Catey V Bunce
- National Institute for Health Research Biomedical Research Centre at Moorfields Eye Hospital and University College London Institute of Ophthalmology, London, United Kingdom
| | - Praveen J Patel
- National Institute for Health Research Biomedical Research Centre at Moorfields Eye Hospital and University College London Institute of Ophthalmology, London, United Kingdom
| | - Catherine A Egan
- National Institute for Health Research Biomedical Research Centre at Moorfields Eye Hospital and University College London Institute of Ophthalmology, London, United Kingdom
| | - James W Bainbridge
- National Institute for Health Research Biomedical Research Centre at Moorfields Eye Hospital and University College London Institute of Ophthalmology, London, United Kingdom
| | - Philip G Hykin
- National Institute for Health Research Biomedical Research Centre at Moorfields Eye Hospital and University College London Institute of Ophthalmology, London, United Kingdom
| |
Collapse
|
39
|
Sim DA, Keane PA, Fung S, Karampelas M, Sadda SR, Fruttiger M, Patel PJ, Tufail A, Egan CA. Quantitative analysis of diabetic macular ischemia using optical coherence tomography. Invest Ophthalmol Vis Sci 2014; 55:417-23. [PMID: 24398090 DOI: 10.1167/iovs.13-12677] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
PURPOSE We described the optical coherence tomography (OCT) features of diabetic macular ischemia (DMI), and correlate these findings with visual acuity (VA). METHODS Clinical and imaging data were collected from 100 patients with type 2 diabetes. Qualitative grading of DMI severity was determined according to criteria defined by the Early Treatment Diabetic Retinopathy Study. Quantitative analysis of foveal avascular zone (FAZ), and OCT images were performed using custom software. RESULTS In all eyes, the outer retina was thicker in eyes with DMI (167.4 ± 18.5 vs. 150.4 ± 31.4 μm, P = 0.04). However, subanalysis of eyes "without macular edema" revealed the converse; outer retinal thinning in eyes with DMI (223.1 ± 31.2 vs. 244.9 ± 37.2 μm, P = 0.007). A thinner retinal nerve fiber layer also was observed to correlate with increasing FAZ size (r = -0.231, P = 0.03), which strengthened in eyes "without macular edema" (r = -0.62, P = 0.001). In the choroid, quantification of its sublayers revealed a thicker Haller's large vessel layer in the presence of DMI (144.3 ± 51.0 vs. 103.5 ± 39.4 μm, P = 0.01). In eyes with DMI, a thicker retina was correlated with worsening VA (r = 0.52, P = 0.001). However, when eyes with macular edema were excluded, a thinner retina was associated with poor VA (r = -0.37, P = 0.004). CONCLUSIONS In eyes with DMI, we observed thinning of the retinal nerve fiber layer, outer retina, and thickening of Haller's large vessel layer of the choroid. These parameters showed good correlation with VA and may serve as a useful tool for monitoring DMI in clinical practice or future clinical trials.
Collapse
Affiliation(s)
- Dawn A Sim
- National Institute for Health Research Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom
| | | | | | | | | | | | | | | | | |
Collapse
|
40
|
Sim DA, Keane PA, Zarranz-Ventura J, Bunce CV, Fruttiger M, Patel PJ, Tufail A, Egan CA. Predictive factors for the progression of diabetic macular ischemia. Am J Ophthalmol 2013; 156:684-92. [PMID: 23891332 DOI: 10.1016/j.ajo.2013.05.033] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2013] [Revised: 05/22/2013] [Accepted: 05/23/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE To investigate the predictive factors for diabetic macular ischemia progression through the analysis of fluorescein angiography (FA) parameters. DESIGN Retrospective, longitudinal study. METHODS Data were collected from 79 eyes of 79 patients with type 2 diabetes mellitus. Macular ischemia severity was assessed using Early Treatment Diabetic Retinopathy Study (ETDRS) protocols and custom software used to quantify the foveal avascular zone (FAZ) area. Patients with ischemia grades "mild," "moderate," or "severe" and at least 2 macula-centered FA images over a minimum of 6 months were included. Main outcome measures were change in macular ischemia grades and FAZ enlargement rate (mm(2)/year). RESULTS The median FAZ areas in mild, moderate, and severe ischemia grades at baseline were 0.28, 0.37, and 0.73 mm(2), and significantly increased at the final FA (0.31, 0.41, and 1.23 mm(2)) (P = .001). The median duration of follow-up was 27.5, 31.0, and 24.0 months, and was not significantly different between groups. FAZ enlargement rates were higher in the more advanced ischemia grades--"severe" (0.073 mm(2) [10.4%]/year) compared to "mild" (0.021 mm(2) [7.50%]/year) (P = .02) or "moderate" (0.019 [5.13%] mm(2)/year) (P = .03). A greater ischemia severity grade was predictive for progression (odds ratio [OR] = 2.47, confidence interval [CI] = 1.21-5.05, P = .02). Macular ischemia progression itself was an independent predictive factor for visual acuity loss (OR = 4.60, CI = 1.54-13.7, P = .03). CONCLUSIONS The rate of FAZ enlargement ranges from 5%-10% of baseline FAZ area per year in eyes with established ischemia. A greater macular ischemia grade was independently predictive for progression, and diabetic macular ischemia progression itself was predictive of the loss of visual function.
Collapse
|
41
|
Fujinami K, Sergouniotis PI, Davidson AE, Wright G, Chana RK, Tsunoda K, Tsubota K, Egan CA, Robson AG, Moore AT, Holder GE, Michaelides M, Webster AR. Clinical and molecular analysis of Stargardt disease with preserved foveal structure and function. Am J Ophthalmol 2013; 156:487-501.e1. [PMID: 23953153 DOI: 10.1016/j.ajo.2013.05.003] [Citation(s) in RCA: 83] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2013] [Revised: 05/06/2013] [Accepted: 05/06/2013] [Indexed: 12/25/2022]
Abstract
PURPOSE To describe a cohort of patients with Stargardt disease who show a foveal-sparing phenotype. DESIGN Retrospective case series. METHODS The foveal-sparing phenotype was defined as foveal preservation on autofluorescence imaging, despite a retinopathy otherwise consistent with Stargardt disease. Forty such individuals were ascertained and a full ophthalmic examination was undertaken. Following mutation screening of ABCA4, the molecular findings were compared with those of patients with Stargardt disease but no foveal sparing. RESULTS The median age of onset and age at examination of 40 patients with the foveal-sparing phenotype were 43.5 and 46.5 years. The median logMAR visual acuity was 0.18. Twenty-two patients (22/40, 55%) had patchy parafoveal atrophy and flecks; 8 (20%) had numerous flecks at the posterior pole without atrophy; 7 (17.5%) had mottled retinal pigment epithelial changes; 2 (5%) had multiple atrophic lesions, extending beyond the arcades; and 1 (2.5%) had a bull's-eye appearance. The median central foveal thickness assessed with spectral-domain optical coherence tomographic images was 183.0 μm (n = 33), with outer retinal tubulation observed in 15 (45%). Twenty-two of 33 subjects (67%) had electrophysiological evidence of macular dysfunction without generalized retinal dysfunction. Disease-causing variants were found in 31 patients (31/40, 78%). There was a higher prevalence of the variant p.Arg2030Gln in the cohort with foveal sparing compared to the group with foveal atrophy (6.45% vs 1.07%). CONCLUSIONS The distinct clinical and molecular characteristics of patients with the foveal-sparing phenotype are described. The presence of 2 distinct phenotypes of Stargardt disease (foveal sparing and foveal atrophy) suggests that there may be more than 1 disease mechanism in ABCA4 retinopathy.
Collapse
Affiliation(s)
- Kaoru Fujinami
- University College London, Institute of Ophthalmology, London, United Kingdom; Moorfields Eye Hospital, London, United Kingdom; Laboratory of Visual Physiology, National Institute of Sensory Organs, National Tokyo Medical Center, Tokyo, Japan; Department of Ophthalmology, Keio University, School of Medicine, Tokyo, Japan
| | - Panagiotis I Sergouniotis
- University College London, Institute of Ophthalmology, London, United Kingdom; Moorfields Eye Hospital, London, United Kingdom
| | - Alice E Davidson
- University College London, Institute of Ophthalmology, London, United Kingdom; Moorfields Eye Hospital, London, United Kingdom
| | - Genevieve Wright
- University College London, Institute of Ophthalmology, London, United Kingdom; Moorfields Eye Hospital, London, United Kingdom
| | - Ravinder K Chana
- University College London, Institute of Ophthalmology, London, United Kingdom; Moorfields Eye Hospital, London, United Kingdom
| | - Kazushige Tsunoda
- Laboratory of Visual Physiology, National Institute of Sensory Organs, National Tokyo Medical Center, Tokyo, Japan
| | - Kazuo Tsubota
- Department of Ophthalmology, Keio University, School of Medicine, Tokyo, Japan
| | - Catherine A Egan
- University College London, Institute of Ophthalmology, London, United Kingdom; Moorfields Eye Hospital, London, United Kingdom
| | - Anthony G Robson
- University College London, Institute of Ophthalmology, London, United Kingdom; Moorfields Eye Hospital, London, United Kingdom
| | - Anthony T Moore
- University College London, Institute of Ophthalmology, London, United Kingdom; Moorfields Eye Hospital, London, United Kingdom
| | - Graham E Holder
- University College London, Institute of Ophthalmology, London, United Kingdom; Moorfields Eye Hospital, London, United Kingdom
| | - Michel Michaelides
- University College London, Institute of Ophthalmology, London, United Kingdom; Moorfields Eye Hospital, London, United Kingdom
| | - Andrew R Webster
- University College London, Institute of Ophthalmology, London, United Kingdom; Moorfields Eye Hospital, London, United Kingdom.
| |
Collapse
|
42
|
Sim DA, Keane PA, Mehta H, Fung S, Zarranz-Ventura J, Fruttiger M, Patel PJ, Egan CA, Tufail A. Repeatability and Reproducibility of Choroidal Vessel Layer Measurements in Diabetic Retinopathy Using Enhanced Depth Optical Coherence Tomography. ACTA ACUST UNITED AC 2013; 54:2893-901. [DOI: 10.1167/iovs.12-11085] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Dawn A. Sim
- Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom 2University College London, Institute of Ophthalmology, London, United Kingdom
| | - Pearse A. Keane
- Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom 2University College London, Institute of Ophthalmology, London, United Kingdom
| | - Hemal Mehta
- Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom
| | - Simon Fung
- Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom
| | | | - Marcus Fruttiger
- University College London, Institute of Ophthalmology, London, United Kingdom
| | - Praveen J. Patel
- Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom 2University College London, Institute of Ophthalmology, London, United Kingdom
| | - Catherine A. Egan
- Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom
| | - Adnan Tufail
- Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom 2University College London, Institute of Ophthalmology, London, United Kingdom
| |
Collapse
|
43
|
Sim DA, Keane PA, Zarranz-Ventura J, Fung S, Powner MB, Platteau E, Bunce CV, Fruttiger M, Patel PJ, Tufail A, Egan CA. The effects of macular ischemia on visual acuity in diabetic retinopathy. Invest Ophthalmol Vis Sci 2013; 54:2353-60. [PMID: 23449720 DOI: 10.1167/iovs.12-11103] [Citation(s) in RCA: 107] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
PURPOSE To investigate the impact of diabetic macular ischemia (DMI) on visual acuity (VA), through the analysis of novel fluorescein angiography (FA) parameters. METHODS Data were retrospectively collected over a 6-month period. DMI severity was graded using Early Treatment Diabetic Retinopathy Study (ETDRS) protocols. Custom software was used to quantify areas of the foveal avascular zone (FAZ), and of capillary nonperfusion over the papillo-macular nerve fiber layer bundle, and temporal macula, and associations tested with VA. RESULTS A total of 488 patients with type 2 diabetes mellitus and FAs of sufficient quality to allow detailed quantitative analyses were included. ETDRS-DMI SEVerity was graded as: none, 39.7%; questionable, 18.4%; mild, 25.2%; moderate, 11.0%; and severe, 5.6%. Median FAZ areas were 0.19 mm(2) (interquartile range [IQR], 0.13-0.25); 0.25 mm(2) (IQR, 0.18-0.32); 0.27 mm(2) (IQR, 0.19-0.38); 0.32 mm(2) (IQR, 0.25-0.54); and 0.78 mm(2) (IQR, 0.60-1.32), respectively, and were significantly different between all grades (P < 0.002), apart from "questionable" versus "mild" grades. Significant association of VA to FAZ area was observed only in the moderate (β = 0.406, SE = 0.101, P = 0.001) and severe (β = 0.299, SE = 0.108, P = 0.006) subgroups, but not in milder ETDRS-DMI grades. A strong association with VA was observed in cases with papillomacular ischemia (β = 1.123, SE = 0.355, P = 0.005), independent of FAZ size or the presence of macular edema. CONCLUSIONS Diabetic macular ischemia is associated with reduced VA in eyes with moderate to severe ETDRS-DMI grades of ischemia but preserved in milder grades. In addition, we describe the independent association of papillomacular nerve fiber bundle ischemia with reduced VA.
Collapse
Affiliation(s)
- Dawn A Sim
- Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
44
|
Povazay B, Hofer B, Torti C, Hermann B, Tumlinson AR, Esmaeelpour M, Egan CA, Bird AC, Drexler W. Impact of enhanced resolution, speed and penetration on three-dimensional retinal optical coherence tomography. Opt Express 2009; 17:4134-50. [PMID: 19259251 DOI: 10.1364/oe.17.004134] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
: Recent substantial developments in light source and detector technology have initiated a paradigm shift in retinal optical coherence tomography (OCT) performance. Broad bandwidth light sources in the 800 nm and 1060 nm wavelength region enable axial OCT resolutions of 2-3 mum and 5-7 mum, respectively. Novel high speed silicon based CMOS cameras at 800 nm and InGaAs based CCD cameras in combination with frequency domain OCT technology enable data acquisition speeds of up to 47,000 A-scans/s at 1060 nm and up to 312,500 A-scans/s at 800 nm. Combining ultrahigh axial resolution, ultrahigh speed OCT at 800 nm with pancorrected adaptive optics allows volumetric in vivo cellular resolution retinal imaging. Commercially available three-dimensional (3D) retinal OCT at 800 nm (20,000 A-scans/s, 6 mum axial resolution) is compared to ultrahigh speed 3D retinal imaging at 800 nm (160,000 A-scans/s, 2-3 mum axial resolution), high speed 3D choroidal imaging at 1060 nm (47,000 Ascan/ second, 6-7 mum axial resolution) and cellular resolution retinal imaging at 800 nm using adaptive optics OCT at 160,000 A-scans/second with isotropic resolution of ~2 mum. Analysis of the performance of these four imaging modalities applied in normal and pathologic eyes focusing on motion artifact free volumetric retinal imaging and revealing novel, complementary morphological information due to enhanced resolution, speed and penetration is presented.
Collapse
Affiliation(s)
- Boris Povazay
- Biomedical Imaging Group, School of Optometry and Vision Sciences, Cardiff UniversityCardiff CF24 4LU, United Kingdom
| | | | | | | | | | | | | | | | | |
Collapse
|
45
|
Fallon J, Jones B, Egan CA. Localized plaques on the sacral area of a child. Clin Exp Dermatol 2008; 34:129-30. [PMID: 19076822 DOI: 10.1111/j.1365-2230.2007.02499.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- J Fallon
- Department of Dermatology, Our Lady of Lourdes Hospital, Drogheda, Ireland.
| | | | | |
Collapse
|
46
|
Sivaprasad S, Webster AR, Egan CA, Bird AC, Tufail A. Clinical course and treatment outcomes of Sorsby fundus dystrophy. Am J Ophthalmol 2008; 146:228-234. [PMID: 18501328 DOI: 10.1016/j.ajo.2008.03.024] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2007] [Revised: 03/23/2008] [Accepted: 03/26/2008] [Indexed: 11/28/2022]
Abstract
PURPOSE To analyze the natural history of Sorsby fundus dystrophy and the effect of various treatment methods for choroidal neovascularization (CNV) in this dystrophy. DESIGN Historical cohort study. METHODS A cohort of 42 patients with the Ser181 Cys TIMP3 mutation were identified from the electronic database of genetic retinal diseases in Moorfields Eye Hospital. Retrospective analyses of case records were carried out. Serial best-corrected visual acuity, fundus findings, age at onset of CNV, initial location of CNV, time taken for CNV to progress to subfoveal location, and the interval between development of CNV in the first and second eye were recorded. The time taken for CNV to recur to a subfoveal location in patients in whom argon laser photocoagulation was carried out for extrafoveal CNV also was documented. In cases where photodynamic therapy (PDT) was carried out for subfoveal CNV, the visual outcome, number of PDT treatments, and progression of lesion size were noted. RESULTS The median age at onset of CNV in the first eye was 46.1 years and in the second eye was 50.3 years. The mean interval between the development of CNV in the first and second eye was 4.5 years. The median age at which vision fell to 20/200 or below was 48 years (first eye) and 54 years (second eye). Argon laser therapy and PDT are not effective in treating CNV of patients with this dystrophy. Antiangiogenic agents may be more effective in this condition. CONCLUSIONS The main cause of blindness resulting from this dystrophy is CNV. Antiangiogenic agents may be useful in preventing visual loss as a result of this condition.
Collapse
Affiliation(s)
- Sobha Sivaprasad
- Medical Retina Service, Moorfields Eye Hospital, London, United Kingdom.
| | | | | | | | | |
Collapse
|
47
|
Jones B, Oh C, Corkery E, Hanley R, Egan CA. Attitudes and perceptions regarding skin cancer and sun protection behaviour in an Irish population. J Eur Acad Dermatol Venereol 2007; 21:1097-101. [PMID: 17714132 DOI: 10.1111/j.1468-3083.2007.02209.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Although people seem to be well educated on the harmful effects of the sun, they continue to intentionally expose themselves without adequate protection. AIMS To ascertain baseline knowledge regarding skin cancer and review the sun protection behaviours in an Irish population and the effect of doctor-based education on these behaviours. METHODS Two hundred participants were recruited for a questionnaire-based study on their perceptions regarding skin cancer and their sun protection behaviour. They were divided into two groups, with one group receiving doctor-based education following the initial survey, and a follow-up questionnaire was carried out within 3 months. RESULTS Ninety per cent of participants knew that sun exposure was the major risk factor for skin cancer, and 95% knew that sun beds were not a safe way to tan. Despite this, < 20% used regular sunscreen, and 30% had used or were currently using sun beds in order to tan. CONCLUSION Our study indicated that although the participants' knowledge of skin cancer and risk of sun exposure is high, their sun-protective attitudes were not influenced by education in the clinical setting.
Collapse
Affiliation(s)
- B Jones
- Department of Dermatology, Our Lady of Lourdes Hospital, Drogheda, Ireland.
| | | | | | | | | |
Collapse
|
48
|
Lamb TJ, Voisine C, Koernig S, Egan CA, Harnett W, Langhorne J. The pathology of Plasmodium chabaudi infection is not ameliorated by the secreted filarial nematode immunomodulatory molecule, ES-62. Parasite Immunol 2007; 29:271-6. [PMID: 17430551 DOI: 10.1111/j.1365-3024.2007.00941.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
ES-62 is a phosphorylcholine-containing glycoprotein secreted by filarial nematodes. This molecule has been shown to reduce the severity of inflammation in collagen-induced arthritis (CIA) in mice, a model of rheumatoid arthritis, via down-regulation of anti-collagen type 1 immune responses. Malaria parasites induce a pro-inflammatory host immune response and many of the symptoms of malaria are immune system-mediated. Therefore we have asked whether the immunomodulatory properties of ES-62 can down-regulate the severity of malaria infection in BALB/c mice infected with Plasmodium chabaudi. We have found that ES-62 has no significant effect on the course of P. chabaudi parasitaemia, and does not significantly affect any of the measures of malaria-induced pathology taken throughout infection.
Collapse
Affiliation(s)
- T J Lamb
- Division of Parasitology, National Institute for Medical Research, The Ridgeway, Mill Hill, London NW7 1AA, UK
| | | | | | | | | | | |
Collapse
|
49
|
Goodridge HS, McGuiness S, Houston KM, Egan CA, Al-Riyami L, Alcocer MJC, Harnett MM, Harnett W. Phosphorylcholine mimics the effects of ES-62 on macrophages and dendritic cells. Parasite Immunol 2007; 29:127-37. [PMID: 17266740 DOI: 10.1111/j.1365-3024.2006.00926.x] [Citation(s) in RCA: 75] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Modulation of macrophage/dendritic cell (DC) cytokine production by the filarial nematode phosphorylcholine (PC)-containing product, ES-62, is mediated by Toll-like receptor (TLR) 4 and signal transduction depends on the TLR adaptor MyD88. Intriguingly, comparison of TLR4 knock-out (ko) mice with TLR4 mutant C3H/HeJ mice indicates that ES-62 cytokine responses are not dependent on the Pro712 residue of TLR4, which is crucial for the response to bacterial lipopolysaccharide (LPS). Because other immunomodulatory effects of ES-62 have been attributed to PC we have now investigated, using PC conjugated to ovalbumin (PC-Ova), whether PC is responsible for the interaction of ES-62 with TLR4. PC-Ova mimicked the modulation of interleukin (IL)-12 production by ES-62 in a TLR4- and MyD88-dependent manner and as with native ES-62, PC-Ova effects were not dependent on Pro712. Furthermore, both native ES-62 and PC-Ova suppressed Akt phosphorylation, whereas neither altered the activation of p38 or Erk MAP kinases. To rule out any role for the ES-62 protein component, we tested a PC-free recombinant ES-62 (rES-62) generated in the yeast Pichia pastoris. Surprisingly, rES-62 also modulated IL-12 production, but in a TLR4/MyD88-independent manner. Furthermore, rES-62 strongly activated both the p38 and Erk MAP kinases and Akt. However, recent biophysical analysis suggests there are differences in folding/shape between native and rES-62 and hence data obtained with the latter should be treated with caution. Nevertheless, although our study indicates that PC is likely to be primarily responsible for the modulation of cytokine production observed with native ES-62, an immunomodulatory role for the protein component cannot be ruled out.
Collapse
Affiliation(s)
- H S Goodridge
- Division of Immunology, Infection and Inflammation, University of Glasgow, Glasgow G11, UK
| | | | | | | | | | | | | | | |
Collapse
|
50
|
Houston KM, Egan CA, García P, Harnett W. Investigation of strategies with potential for producing a phosphorylcholine-free version of the filarial nematode immunomodulator, ES-62. J Helminthol 2006; 80:261-5. [PMID: 16923269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
Phosphorylcholine (PC) is found attached to N-type glycans of proteins secreted by filarial nematodes, where it appears to act as an immunomodulator. Based on information on the structure and biosynthesis of the PC-glycan of a major secreted protein, ES-62, strategies were designed with potential for preparing PC-free material to better understand the importance of PC in filarial nematode immunomodulation. The strategies involve either enzymatic removal of PC or inhibition of its attachment during ES-62 synthesis. No method tested was found to be 100% effective although approximately 70% removal was obtained by culturing worms in Et18OCH3. Reasons for failure to obtain complete absence of PC moieties are discussed in relation to the structure and synthesis of PC-glycans and in addition PC-glycan biosynthesis is briefly commented on as a target for chemotherapy.
Collapse
Affiliation(s)
- K M Houston
- Department of Immunology, University of Strathclyde, Glasgow, G4 0NR, UK
| | | | | | | |
Collapse
|